ST depression morphology

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So I had a patient who was awaiting CABG after an outpatient cath revealed 95% Left main lesions, 90% RCA, and 60% LAD. He was on a Nitroglcyerin gtt and IABP. He started to complaining of chest pain and it revealed 0.7mm ST depression in lateral leads, and we adjusted the nitro and gave morphine with the MD at bedside. Then a couple hours later, the patient began to c/o chest pain again, we did a repeat EKG, let the MD know who came to the bedside.

The EKG showed 0.7mm ST depression in the lateral leads, however the MD stated that it actually looked much worse then the previous EKG because the ST depression on the second EKG appeared slight coved compared to the ST depression on the first EKG which was straight, though both ST segments didn't deviate from a consistent 0.7mm depression.

The patient's pain was resolved with the Morphine and Nitroglycerin titration, so no further intervention was taken.

I just wanted to know if a coved ST-depression is in fact a negative sign, and if so, if there's any literature I can review to better understand it.

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Specializes in cardiology, and critical care.

https://litfl.com/st-segment-ecg-library/

the bit you want is fairly far down, but ST-depression has 3 basic morphologies, up-sloping, down-sloping and horizontal.

up-sloping (looks coved) is non indicative of myocardial ischaemia.

as to the mechanism behind this, not a clue.

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Specializes in SICU Nurse.

It is my understanding that ST Depression unless in posterior leads indicates necrosis and not acute ischemia.

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Specializes in anesthesiology.
On 10/25/2019 at 9:41 PM, SICUMurse123 said:

It is my understanding that ST Depression unless in posterior leads indicates necrosis and not acute ischemia.

nah, man. Rapid Interpretation of EKGs is a great book to learn about EKGs if you're interested.

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