Tombstone ST elevation

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Tombstone ST elevation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Tombstone ST elevation is an electrocardiographic pattern of ST segment elevation whereby the QRS complex, the ST segment and the T wave merge to form a large upright monophasic deflection called a "tombstone"[1][2][3][4]. This electrocardiographic pattern has been associated with poorer clinical outcomes in the setting of ST segment elevation myocardial infarction.

Criteria

  1. The R wave is absent or its duration is <0.04 seconds with minimal amplitude;
  2. The ST segment is convex upward and merges with the descending limb of the R wave or the ascending limb of the QS wave;
  3. The peak of the convex ST segment is higher than whatever remains of the R wave; and
  4. The convex ST segment merges with the ascending limb of the T wave.

Example

Source:http://pradubsukhum.com/ECG/MI/MI%20tables/Evolving%20ST%20T%20abnormalities%20in%20acute%20ST%20elevation%20MI.html

Source: http://pradubsukhum.com/ECG/MI/MI%20tables/Evolving%20ST%20T%20abnormalities%20in%20acute%20ST%20elevation%20MI.html

References

  1. Wimalaratna HS. “Tombstoning” of ST segment in acute myocardial infarction. Lancet 1993; 342 (8869): 496.
  2. Guo XH, Yap YG, Chen LJ, et al. Correlation of coronary angiography with “tombstoning” electrocardiographic pattern in patients after acute myocardial infarction. Clin Cardiol 2000; 23: 347-52.
  3. Balci B, Yesildag O. Correlation between clinical findings and the “tombstoning” electrocardiographic pattern in patients with anterior wall acute myocardial infarction. Am J Cardiol 2003; 92: 1316-8.
  4. Birnbaum Y, Sclarovsky S. “Tombstoning” of ST segment in acute myocardial infarction. Lancet 1993; 342: 1494.

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