ST (J) vs TP baseline (after T wave)

• Pericardial leads: > 2 mm
• Limb leads: > 1mm
• Opposite leads can show ST Depression
• Shows in at least 2 contagious leads
  • Anterior: V1-V4: LAD
  • Septal: V1-V2: septal perforating branch → reciprocal ST Depression of posterior
  • Lateral: V5-V6, avL, I: circumflex → reciprocal ST Depression of inferior
  • Inferior: II, III, avF: RCA → reciprocal ST Depression of lateral

DDx

• STEMI (Most common cause), STEMI ECG (Tombstone)
  • Clinical Context
  • Contagious lead
  • Reciprocal Changes
• Pericarditis (concave)
• Benign Early repolarization (J point elevation)
  • benign, often seen in young adult
  • need context, check opposite lead for reciprocal changes
• Brugada syndrome (rare genetic condition)
• Global ST Depression and Elevation in aVR = "STEMI-equivalent"
  • !ACS - Acute coronary syndrome
    • can indicate severe left main or multi-vessel coronary artery disease.