Excessive discordant ST elevation
Groups of Signs
Variations: ST segment
- Normal ST segment
- Tombstone ST elevation
- Downsloping ST depression
- Upsloping ST depression
- Straightened ST segment
- Flat ST segment
- Saddleback ST elevation
- Horizontal ST depression
- Widespread ST elevation
- Inferior ST elevation
- Anterior ST elevation
- Lateral ST elevation
- Anterior ST depression
- Widespread ST depression
- ST elevation in aVR
- ST elevation in posterior leads V7-9
- ST elevation in V4R
- Inferior ST depression
- Septal ST elevation
- Lateral ST depression
- Reciprocal ST depression
- ST elevation in aVL
- Coved ST elevation
- Concordant ST elevation
- Discordant ST changes
- ST elevation in III>II
- ST elevation in V1
- ST elevation in a PVC
- Excessive discordant ST elevation
- Concordant ST depression in V1-V3
- Pseudonormalised ST segment
- Excessive discordant ST depression.
- Shark fin ST elevation
ECG Library: Excessive discordant ST elevation (28)
This ECG is from a woman in her 70s who was awoken with sharp chest pain on a background of cardiomyopathy, ICD and LVH.
This ECG shows paced rhythm with modified-Sgarbossa positive discordant ST elevation in I, aVL and V2. Angiogram did not find a culprit and echo did not find a wall motion abnormality. The cause remains a mystery.
This ECG is from an elderly woman who presented with 2 hours of chest pain on a background of multiple stents, a pacemaker, stroke and COPD.
This ECG shows paced rhythm with excessively discordant ST segments (modified Sgarbossa positive). The cause was a 95% thrombotic lesion of the RCA.
This ECG is from a man in his 70s who presented with epigastric pain.
This ECG shows These discordant ST changes are excessive and do meet Modified-Sgarbossa criteria. This was missed. The patient went into VF shortly after and died.
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 an elderly male who presented with chest pain. He has a pacemaker. This was his second prehospital ECG.
This ECG shows ventricular paced rhythm with excessive discordant ST elevation in V3 as well as concordant ST elevation in V2 and V4. The cause was most likely a proximal LAD or left main occlusion. This was missed and the patient died.
This ECG is from a man in his 50s who presented with 1 hour of chest pain and shortness of breath. This was his second ECG after he suddenly became more short of breath.
This ECG is from a man in his 60s who presented with chest pain for several hours on a background of prior coronary artery disease and hypertension.
This ECG shows LBBB with excessively discordant ST elevation in inferior leads with reciprocal changes in I and aVL. The cause was a RCA in-stent restenosis.
This ECG is from a middle-aged male who presented with paroxysmal nocturnal dyspnoea and hypoxia on a background of heart failure, biventricular pacemaker, ICD and previous LV thrombus.
This ECG shows biventricular paced rhythm with RBBB-like morphology and discordant ST elevation in I, aVL, V3-5 due to acutely decompensated heart failure.
This ECG is from a middle aged woman who presented with sudden severe substernal chest pain on a background of idiopathic cardiomyopathy and biventricular failure.
This ECG shows LBBB (not paced rhythm) with excessive discordant ST elevation in III and aVF with reciprocal change in aVL. The cause was an acute lateral MI, likely due to embolism from a left atrial appendage thrombus.
This ECG is from an elderly woman who presented with chest pain on a background of a normal angiogram 3 months prior.
This ECG shows ventricular paced rhythm (likely biventricular) with concordant ST depression in III, aVF and V3. There is excessive discordant ST elevation in I and aVL. The cause was an acute left main occlusion due to suspected embolism.
This ECG is from a woman in her 80s who presented with chest pain. She had a history of 2nd degree AV block with PPM in-situ. This repeat ECG was recorded 60 min after presentation when she had further chest pain.
This ECG shows ventricular pacing with concordant ST elevation in I and V6, and excessive discordant ST elevation in V2-4. The cause was an acute anterior MI.
This ECG is from a female in her 60s presented with 2-3 days of fatigue and shortness of breath. She called EMS when her symptoms acutely worsened while she was shopping. EMS arrived and recorded a heart rate of 27. On arrival to the ED she was noted to be in complete heart block. She was given atropine with transient increase in HR to 80s. This ECG was recorded later that night after a transvenous pacemaker was placed.
This ECG shows ventricular paced rhythm with excessive discordant ST elevation in II, III and aVF. There is reciprocal depression in aVL and I. The cause was an occluded proximal right coronary artery. This diagnosis was delayed and the patient died.
Where did they come from?
These ECGs were collected from Free Open Access Medical Education (#FOAMed) blogs, with the permission of their authors. You can find out more about each ECG's source by clicking on it.
Why are they here?
This is an experiment in digital curation. The idea is to collect resources to increase awareness and accessibility. Over time, more ECGs in the collection will be tagged to make it easier to find them and reused in new interactive quizzes.
How can I use these ECGs?
You can use these ECGs for your own learning, teaching or research - as long as you abide by the terms of each ECG's copyright licence as stipulated by the original author.