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The ST segment
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Elevation of the ST segment is sometimes seen in the chest leads (most commonly V2–V5) as a variant of the normal ECG, particularly in patients <50 years of age, and is referred to as ‘high take-off’ or ‘benign early repolarization’. A high take-off ST segment is stable, not changing over time, and is not associated with reciprocal ST segment depression; compare its appearances in Figure 15.15 with the earlier ECGs in this chapter. The ST segment has an upward concavity which merges into the ascending limb of the T wave; the descending limb of the T wave tends to be steeper. Whenever you suspect ST segment elevation to be just high take-off, always endeavour to find earlier ECGs for confirmation.
A guide to ECG interpretation
Published in Swati Gupta, Alexandra Marsh, David Dunleavy, Kevin Channer, Cardiology and the Cardiovascular System on the move, 2015
Swati Gupta, Alexandra Marsh, David Dunleavy, Kevin Channer
Benign early repolarization (‘high take-off’) is a normal variant seen in people mainly under the age of 50 years and presents with concave ST segment elevation mainly in the anterior precordial leads (may be difficult to differentiate from pathological ST segment elevation).
Trazodone overdose–induced Prinzmetal’s angina pectoris
Published in Baylor University Medical Center Proceedings, 2020
Bhesh Raj Karki, Paritosh Prasai, Asim Ruhela, Yub Raj Sedhai
The typical presentation along with supportive ECG findings in our patient raised a high suspicion of acute ST-segment elevation myocardial infarction. However, he was young and did not have atherosclerotic risk factors other than smoking. Further, his Thrombolysis in Myocardial Infarction score was 1, and his Global Registry of Acute Coronary Events score was 66. Thus, we considered the possibility of nonatherosclerotic causes. Urinary drug screen was negative for vasoactive substances. Given the history of newly diagnosed depression and ongoing history of emotional stress, the possibility of takotsubo cardiomyopathy was considered. However, normal cardiac enzymes and the absence of transient left ventricular systolic dysfunction (hypokinesis, akinesis, or dyskinesis) in 2D echocardiography made it unlikely.2,3 Benign early repolarization was a possibility given his young age; however, the ECG did not show J point elevation, and the ST-segment elevation followed a specific vascular territory. Because the repeat ECG revealed resolution of ST-segment elevation, the possible cause was a reversible process, likely vasospasm of the epicardial coronary artery.