Elias Hanna, Cardiology

Differential diagnosis of ST depression or T inversion

Hanna EB, Glancy DL. CCJM June 2011

Non-STelevation
ischemia

STelevation
ischemia

Differential diagnosis of ST elevation:

LVH

LBBB

Pericarditis

Early repolarization

Hyperkalemia

STEMI
ST and T
both
opposite
direction
QRS

ST and T
both
opposite
direction
to QRS

-PR
depression

-Notched J point

Narrow- based
peaked T
pulling ST
segment

1- ST Convex upward
2-Wide upright T or
inverted T
-ST<5
-ST<3 mm
3-Reciprocal ST
mm
depression
4-Q waves
In addition to their specific features, the 5 diagnoses that are not STEMI should not have any of the STEMI
features: ST usually concave upward, no wide upright or inverted T wave, no reciprocal ST changes, no Q wave.