Excessive discordant ST depression is ST depression with a positive and wide QRS complex. If the depression is > 30% of the R wave height in the presence of a LBBB, it suggests coronary occlusion with a sensitivity of 100% and specificity of 88%.See also: ST segment
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This ECG is from a man in his 70s who presented with intermittent dyspnoea and chest pain over the past 2 weeks. He had a history of a pacemaker, heart failure, aortic stenosis, diabetes, hypertension, stroke, ischemic heart disease, chronic kidney disease and peripheral vascular disease. This was his initial ECG.
This ECG shows a wide complex tachycardia with ventricular pacing. The excessively discordant ST changes in V4-6 and aVR suggested diffuse subendocardial ischemia. He was found to have severe three vessel disease and a proximal left circumflex stenosis was stented.
This ECG is from a very elderly woman who presented with shortness of breath, chest and back pain intermittently for several nights. It was relieved by isosorbide, but when she lost this medication she became worse. She had a background of CAD, ischemic cardiomyopathy and heart failure with an ICD in situ for primary prevention. On arrival she was hypoxic (SpO2 88%) with a good BP and HR 90, but improved on CPAP then BIPAP. This was her initial ECG.