Key result
Prominent reciprocal ST depression with minimal ST elevation can obscure acute transmural infarction on ECG.
Why the study?
Reciprocal ST segment depressions are usually less marked than primary ST segment elevations in acute transmural infarction, but unusual cases with predominant reciprocal depressions exist that may impede diagnosis and localization.
Case Report (n=2)
Recognizing that prominent reciprocal ST depression with minimal primary ST elevation can be the primary ECG sign of acute infarction is crucial to avoid missing the diagnosis.
In most cases of acute transmural infarction, the reciprocal ST segment depressions observed in contralateral leads are less marked than the primary ST segment elevations. Two unusual cases are presented where reciprocal ST depressions were the predominant findings due to the orientation of the injury current vector. Failure to recognize this pattern may impede the diagnosis and localization of acute infarction. Furthermore, these cases illustrate the principle that "hyperacute" T waves may only appear as a slight, relative increase in T wave positivity rather than as a marked absolute increase in T wave amplitude.
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Barold et al. (1981) conducted a case report in Acute transmural infarction (n=2). Prominent reciprocal ST depression with minimal primary ST elevation was evaluated on Diagnosis and localization of acute infarction. Prominent reciprocal ST depression with minimal primary ST elevation can be the predominant ECG finding in acute transmural infarction, which may impede diagnosis if unrecognized.
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