Q. What are changes in ST-Segment?

Normal Exercise Electrocardiogram ST and J Point

As the heart rate increases with exercise, a number of predictable changes occur in a normal ECG tracing. The PR-interval is shortened after 1 minute of exercise. The P-wave becomes taller and the Ta wave (wave of atrial repolarisation) increases, resulting in downward displacement of the PQ junction. This is particularly important because the so called baseline, for terms of evaluating ST-segment change, is below that usually considered to be isoelectric tracing. With exercise, the Ta wave tends to extend through the QRS and may influence that junction between the ST-segment and the T-wave.

Prognostic Significance

Asymptomatic patient-Abnormal test prevalence 5 to 12 per cent. Risk of event-9 times greater in abnormal test. 2 per cent event rate (angina) over 4 year follow up. BLS study - with risk factors- elderly patient - event rate varies 3.5 per cent to19 per cent in 9 years follow up. Females- 15 per cent to 20 per cent prevalence-less prognostic value.

Symptomatic Patient: Case Study

First stage positive: 5 per cent annual mortality, Low risk group: < 1 per cent annual mortality. It has become standard practice to use the line of PQ or PR junction as a marker for the baseline when the ST-segment is measured at one fourth the distance between the QRS and peak T in left to right leads, considerable depression is normally seen. The anterior posterior lead changes (V1 to V2) are less prominent than those in the lateral and vertical leads. The absence of significant ST-segment depression in young, vigorous boys and in athletic, middle aged men, suggests that the effect of the Ta wave, can usually be recognized because of the short duration (usually 0.045) of the J point depression.