What are the images of ST segment elevation?

From the Guidelines

ST segment elevation is a critical indicator of acute myocardial injury, and its diagnosis and management should be guided by the most recent and highest quality evidence, which recommends a threshold of at least 2.5 mm in men < 40 years, 2 mm in men ≥ 40 years, or 1.5 mm in women in leads V2–V3 and/or 1 mm in the other leads for STEMI diagnosis 1.

Key Considerations

• The diagnosis of STEMI is typically based on symptoms consistent with myocardial ischemia and signs, including a 12-lead electrocardiogram (ECG) showing ST-segment elevation in two or more contiguous leads 1.
• The ECG criteria for STEMI diagnosis are based on changes of electrical currents of the heart, with standard calibration of the ECG being 10mm/mV, and therefore 0.1 mV equals 1 mm square on the vertical axis 1.
• In patients with a clinical suspicion of myocardial ischemia and ST-segment elevation, reperfusion therapy needs to be initiated as soon as possible, with primary percutaneous coronary intervention (PCI) or fibrinolytic therapy being the recommended treatments 1.
• The pattern of leads showing elevation helps identify which area of the heart is affected, including anterior, lateral, inferior, or posterior regions 1.

Clinical Context

• ST elevation is not always due to heart attacks and can also appear in conditions like pericarditis, early repolarization, left ventricular aneurysm, or Brugada syndrome 1.
• When evaluating ST elevations, it's crucial to consider the clinical context, as STEMI requires immediate reperfusion therapy to improve morbidity, mortality, and quality of life outcomes 1.
• The underlying mechanism involves injury currents flowing from damaged myocardial cells, creating the characteristic ECG changes that help guide life-saving interventions 1.

Management

• A working diagnosis of STEMI must be made based on symptoms and ECG signs, with a reduction in chest pain after nitroglycerin administration not recommended as a diagnostic maneuver 1.
• ECG monitoring should be initiated as soon as possible in all patients with suspected STEMI to detect life-threatening arrhythmias and allow prompt defibrillation if indicated 1.
• If the ECG is equivocal or does not show evidence to support the clinical suspicion of MI, ECGs should be repeated and compared with previous recordings 1.

From the Research

ST Segment Elevation Images

• ST segment elevation is a critical indicator of myocardial infarction, particularly in the context of ST-segment elevation myocardial infarction (STEMI) 2.
• The management of STEMI involves prompt reperfusion therapy, which can be achieved through primary percutaneous coronary intervention (PCI) or thrombolytic therapy 3, 2.
• The use of antiplatelet agents, such as clopidogrel and aspirin, is crucial in the management of STEMI, as they help to prevent further thrombus formation and improve outcomes 4, 5.
• Imaging techniques, including electrocardiography, cardiac magnetic resonance imaging, and coronary angiography, play a vital role in the diagnosis and management of STEMI 6.
• The pathophysiology of STEMI involves the rupture of a coronary artery plaque, leading to thrombus formation and occlusion, which can be influenced by underlying risk factors such as atherosclerosis, hypertension, and diabetes 6.

Diagnostic Strategies

• Electrocardiography remains the cornerstone of STEMI diagnosis, with ST segment elevation being a key indicator of myocardial infarction 2, 6.
• Advances in imaging techniques have enhanced the accuracy of STEMI diagnosis and allow for better risk stratification 6.
• The use of cardiac magnetic resonance imaging and coronary angiography can provide valuable information on the extent of myocardial damage and the presence of coronary artery disease 6.

Treatment Approaches

• Prompt reperfusion therapy is essential in the management of STEMI, with primary PCI being the preferred approach if it can be performed within 120 minutes of STEMI diagnosis 3, 2.
• Thrombolytic therapy is an alternative approach if primary PCI cannot be performed within the recommended time frame 3, 2.
• The use of antiplatelet agents, beta-blockers, and statins is crucial in the post-STEMI management, as they help to prevent further thrombus formation and improve outcomes 3, 4, 6.