ST-segment depression

Patient

50-year-old woman with familial hypertrophic cardiomyopathy;

Trace

Signs of left ventricular hypertrophy with positive Sokolow criterion (40), slightly widened QRS (100 ms), delayed intrinsicoid deflection in V4, V6; ST segment depression in leads I, aVL, V4, V5, V6 with negative T-waves;

Patient

65-year-old man, non-insulin-dependent diabetic, hypertensive, hospitalized for chest pain of increasing intensity, initially occurring on exertion and thereafter at rest since 2 days; increased troponin;

Trace

This per-critical electrocardiogram shows a sinus rhythm of 95 bpm, with a ST segment elevation of 3 mm in aVR, of 2 mm in V1 and a widespread and relatively prominent ST segment depression (inferior leads, V3-V6);

Exergue

In the presence of chest pain and ST segment depression, certain signs are suggestive of an ischemic origin: rectilinear, horizontal or descending depression in at least 2 contiguous leads corresponding to a defined territory; the greater the amplitude of the depression, the greater likelihood of an acute coronary origin (a depression ≥ 2 mm in several leads is highly evocative).