Ischæmic ST Segment Depression

Report:

Sinus rhythm 69/min

Right axis deviation +95o

ST segment depression c/w ischæmia

Comment:

The patient had unstable angina and her ECG reflects her coronary disease. The ST segments are over 1 mm depressed, horizontal (“plane” depression) and the ST/T angle is sharper than normal. Concerning the last and referring to the fact that normal ST segment blends gradually into the T wave, one of my teachers47 used to joke that ST figment is a segment of the imagination!

Female ST segment depression abounds with false positives but, in conjunction with typical pain, remains diagnostically valid. The patient obviously requires angiography before too long. A normal study in her case would favour syndrome X48, whatever it may be.

In general, women with acute coronary syndromes tend to have less “typical” presentations than men, but this is not of great diagnostic value49.

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