Measurement
1. Measure at 0.04 sec (1 mm) after the J-Point
2. Compare to baseline (line drawn from P start to T end)
Causes
1. Acute Myocardial Infarction
  1. SEE EKG changes in acute MI
2. Pericarditis
  1. Diffuse ST elevation
3. Left Bundle Branch Block
  1. Findings
    1. Left Bundle Branch Block in lead V1
    2. QRS Duration > 120 ms
    3. QRS Complex negative (down) in V1
  2. Left ventricular activation delay
    1. Hides ST segment elevation
    2. Evaluate new LBBB as Acute Coronary Syndrome
4. Pacemaker with paced beats from right ventricle
  1. Left Bundle Branch Block in V1 with pacer spike
  2. Not possible to diagnose Acute MI
5. Left Ventricular Hypertrophy
  1. Increased QRS Complex amplitude
  2. ST segment elevation/depression in precordial leads
  3. T Wave direction opposite to QRS Complex
  4. Not possible to diagnose Acute MI
6. Early Repolarization
  1. ST elevation in lateral leads (V5, V6, I, aVL)
    1. Elevation is coved/concave
  2. More common in black men, young and in good health

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.