4.3
Code 4.3 — Minnesota Code 4-3: down-sloping ST segment without significant J depression. The J point is depressed by less than 0.5 mm, but the ST segment slopes downward and the lowest point of the T wave (or of the ST-T junction) lies at least 0.5 mm below the PR baseline. This is a mild, "minor" repolarisation abnormality. It may reflect early or slight ischaemia, hypertrophy, the effect of drugs, or be non-specific.
Possible causes
- Mild or intermittent myocardial ischaemia
- Left ventricular hypertrophy (early strain pattern)
- Digoxin and other medicines, electrolyte disturbances
- Changes after tachycardia, hyperventilation, posture, meals
- Non-specific variants without heart disease
Clinical significance
On its own this finding is not diagnostic. It is assessed together with symptoms, risk factors and other ECG changes. In epidemiological studies, minor ST-T abnormalities, including this pattern, have been associated with a moderate increase in long-term cardiovascular risk. They are therefore a reason to check and treat risk factors.
Show the ECG to a doctor, especially if you have exertional discomfort in the chest, breathlessness, diabetes or high blood pressure. Comparison with earlier ECGs helps decide whether the change is new.
if the finding comes with chest pain, breathlessness, cold sweat or fainting.
References
- Prineas RJ, Crow RS, Zhang ZM. The Minnesota Code Manual of Electrocardiographic Findings. 2nd ed. London: Springer; 2010. doi:10.1007/978-1-84882-778-3
- Rautaharju PM, Surawicz B, Gettes LS. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval. Circulation. 2009;119(10):e241–e250. doi:10.1161/CIRCULATIONAHA.108.191096
This article is for general information and does not replace a consultation with a doctor. ECG findings must be interpreted by a physician together with symptoms and other tests.
Published on 14 May 2019