Reciprocal ST depression

Reciprocal ST depression occurs in the leads that are electrically opposite from those showing ST elevation during an acute infarction. For example, inferior coronary occlusion is associated with reciprocal ST depression in aVL, lateral infarction with III / aVF, and posterior infarction with reciprocal ST depression in V1-3.

See also: ST segment

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ECG Library (55)

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In the ECGquest archives, this ECG has been tagged with: - Abdominal pain Chest pain 12-Lead Reciprocal ST depression ST elevation in aVL Acute Lateral MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
Epigastric pain radiating to the chest for 18 hours. ECG makes the Dx. Troponin makes the Dx. CT makes the Dx!

This ECG is from a middle aged man who presented with 18 hours of epigastric pain radiating to the chest.

This ECG shows ST elevation in aVL with reciprocal ST depression in inferior leads and V3-4, consistent with high lateral MI and posterior involvement.

In the ECGquest archives, this ECG has been tagged with: - Dyspnoea 12-Lead Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
A Patient with Respiratory Failure and a Computer “Normal” ECG

This ECG is from a patient of unknown age who had recurrent presentations for shortness of breath due to asthma.

This ECG shows subtle ST elevation in III with reciprocal change in aVL. The cause was inferior MI.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Incorrect Machine Interpretation Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
Chest pain resolved, and a “Normal” ED ECG

This ECG is from a middle aged male who presented with chest pain. He was pain free at the time of this initial ECG.

This ECG shows subtle inferior ST elevation with reciprocal change in aVL. The cause was a large inferior infarct.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Inferior ST elevation Reciprocal ST depression Acute Inferior MI EMergucate CC-BY-NC-SA
ECG of the Week – 5th March 2019 – Interpretation

This ECG is from a man in his 50s who presented with left sided chest pain.

This ECG shows ST elevation in inferior leads with reciprocal changes in aVL and I

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Inferior ST elevation Reciprocal ST depression Acute Inferior MI Acute Posterior MI Right ventricular MI ECG Guru CC-BY-NC-SA
Instructors’ Collection ECG: Inferior Wall M.I. With Atrial Fibrillation or Atrial Flutter

This ECG is from a man in his 70s who presented with chest pain. He had a history of COPD.

This ECG shows massive inferior ST elevation with widespread ST depression. The most likely cause was an acute inferior infarct.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Inferior ST elevation Peaked T waves Reciprocal ST depression ST elevation in V1 Right ventricular MI Dr Smith's ECG Blog CC BY-NC
The Interventionalist Refuses Angiography, and even to speak to the Emergency Physician – repeat ECG pain free

This ECG is from a middle aged patient who presented with chest pain of uncertain duration. This was the repeat ECG when pain returned.

This ECG shows ST elevation in V1, II, III and aVF with reciprocal ST depression in aVL. The cause was a proximal RCA occlusion. The T waves were peaked but the potassium was normal.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Incorrect Machine Interpretation Inferior ST elevation Reciprocal ST depression Acute Inferior MI Dr Smith's ECG Blog CC BY-NC
The computer calls this a “normal ECG”. We’ll just keep making this point.

This ECG is from a middle aged woman who presented with chest pain and dyspnoea that improved after nitrogylcerin.

This ECG shows subtle ST elevation in inferior leads with reciprocal changes in aVL. Troponins were positive. The computer misinterpreted the ECG as normal.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Reciprocal ST depression Septal ST elevation Proximal LAD occlusion Dr Smith's ECG Blog CC BY-NC
A woman in her 70s with chest pain

This ECG is from a woman in her 70s who presented with central chest pain. This was the initial ECG.

This ECG shows ST elevation in V1-2 with ST depression in V4-6 as well as I, II and aVF. R wave progression is also poor. V1 is concerning for a hyperacute T wave. The chest pain worsened and the ECG changes evolved to meet STEMI criteria. Troponin was elevated. Catheterisation found a 100% proximal LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Absent P waves Anterior ST depression Extreme tachycardia Inferior ST elevation Narrow QRS Normal Axis Reciprocal ST depression Regular Tachycardia Atrial flutter Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

This ECG is from a man in his 60s who presented with intermittent shortness of breath and chest pressure over the past few days. This was his initial ECG.

This ECG shows a regular narrow complex tachycardia around 200 bpm, without P waves, with marked ST elevation in inferior leads and ST depression in anterior leads and aVL. The cause was thought to be atrial flutter from newly started flecainide. He also underwent angiography and had stents inserted to the left circumflex and right coronary arteries.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Dyspnoea 12-Lead Anterior ST depression Inferior ST elevation Narrow QRS Normal Axis Normal P waves Reciprocal ST depression Regular Tachycardia Sinus tachycardia Multi-vessel disease Dr Smith's ECG Blog CC BY-NC
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide. Repeat 1 min later.

This ECG is from a man in his 60s who presented with intermittent shortness of breath and chest pressure over the past few days. This was his repeat ECG after the rhythm changed.

This ECG shows a sinus tachycardia with ST elevation in inferior leads and ST depression in anterior leads and aVL. He underwent angiography and had stents inserted to the left circumflex and right coronary arteries.

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