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    9.2
    Home > ECG findings

    9.2

    Minnesota Code 9-2: ST-segment elevation — STEMI criteria, pericarditis, early repolarisation and other causes; emergency signs.

    Code 9.2 — Minnesota Code 9-2: ST-segment elevation. The ST junction (J point) is raised above the PR baseline by 1.0 mm or more in limb leads or V5–V6, or by 2.0 mm or more in V1–V4. ST elevation can be the main sign of an acute myocardial infarction (STEMI), which requires immediate treatment. It also occurs in pericarditis and early repolarisation, after an infarction (ventricular aneurysm), and in several other conditions.

    Minnesota Code 9ST elevationAcute myocardial infarction
    Limb leads, V5–V6ST ≥ 1.0 mm
    V1–V4ST ≥ 2.0 mm
    STEMI (UDMI)new, in 2 contiguous leads
    Urgencymay be an emergency
    Normal ST segment compared with convex ST elevation of acute myocardial infarction and concave ST elevation of early repolarisation Normal ST at baseline Acute MI convex ST ↑ Early repolarisation concave ST ↑
    Figure 1. Left: normal. Middle: convex ('dome-shaped') ST elevation merging with the T wave — typical of acute infarction. Right: concave ST elevation with J-point notching and tall T — typical of benign early repolarisation.

    STEMI criteria (Fourth Universal Definition of MI)

    New ST elevation at the J point in two contiguous leads: ≥ 1 mm in all leads other than V2–V3. In V2–V3 the threshold is ≥ 2 mm in men aged 40 or over, ≥ 2.5 mm in men under 40, and ≥ 1.5 mm in women of any age. Reciprocal ST depression in the opposite leads strongly supports an acute infarction.

    Causes of ST elevation

    CauseClues
    Acute myocardial infarction (STEMI)Chest pain; convex ST in a coronary territory; reciprocal depression; dynamic changes
    Acute pericarditisDiffuse concave ST elevation, PR depression, pleuritic pain, friction rub
    Early repolarisationYoung people, athletes; J-point notching; stable over time
    Left ventricular aneurysmPersistent ST elevation with Q waves after an old infarction
    LBBB, LVH, paced rhythmSecondary ST changes discordant with the QRS
    Brugada patternCoved ST elevation in V1–V2 with negative T
    Takotsubo, myocarditis, hyperkalaemiaClinical context, laboratory tests
    Call emergency services immediately

    if ST elevation is found together with chest pain or pressure, pain in the arm, jaw or back, breathlessness, cold sweat, nausea or fainting. In STEMI every minute counts: rapid opening of the artery (primary PCI) saves heart muscle. Do not drive yourself.

    References

    1. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237–269. doi:10.1093/eurheartj/ehy462
    2. 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
    3. 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

    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