ST segment

곽충환 대한부정맥학회 2017 International Journal of Arrhythmia Vol.18 No.2

The ST segment corresponds to the plateau phase of ventricular repolarization, i.e., phase 2 of the action potential. Heightened awareness of the characteristic patterns of ST segment changes is vital to quickly identifying life-threatening disorders. The differential diagnosis of ST segment elevation includes four major processes: ST segment elevation myocardial infarction (STEMI); early repolarization; pericarditis; and ST elevation secondary to an abnormality of the QRS complex (left bundle branch block, left ventricular hypertrophy, or preexcitation). Other processes that may be associated with ST elevation include hyperkalemia, pulmonary embolism, and Brugada syndrome. Two particular patterns of ST segment depression reflect STEMI rather than non-ST-segment elevation acute coronary syndrome: ST segment depression that is reciprocal to a subtle and sometimes overlooked ST-segment elevation, and ST segment depression that is maximal in leads V1-V3, suggesting true posterior infarction. The clinical setting and specific electrocardiographic criteria often allow identification of the cause.

과체중 및 비만 여성에서 운동 후 ST 분절의 상승과 심박수-회복 궤도(Rate-Recovery Loop)의 변화

고성경,최건식 한국운동과학회 2004 운동과학 Vol.13 No.2

고성경, 최건식. 과체중 및 비만 여성에서 운동 후 ST분절의 상승과 심박수-회복 궤도(Rate-Recovery Loop)의 변화. 운동과학, 제13권 2호, 167-176, 2004. 과체중 및 비만이 운동 및 운동 후 ST 분절의 상승에 미치는 영향과 심박수-회복궤도(Rate-Recovery Loop)를 이용한 관상동맥 질환 위험도를 진단하기 위하여 25-40세의 여성 50명을 대상으로 최대하 운동부하 검사를 실시하였다. 운동부하 검사 시 ST 분절은 V5 유도에서 측정하였다. 연구결과 운동시 ST 분절은 운동 시간에 따라 그 값이 하강하는 경향이 있었으며 특히 과체중 Ⅰ, Ⅱ군과 비만군의 ST 분절이 100㎶ 이하로 하강하였다. 동일집단에서 안정시 ST 분절에 비해 정상체중군은 6분과 최대하 운동시의 값이 유의하게 낮았으며, 과체중 Ⅰ군은 최대하 운동과 회복 1분의 값이 유의하게 차이가 있었다. 과체중 Ⅱ군은 6분과 최대하 운동 및 회복 1분의 ST 분절이 안정시에 비해 차이가 있었으며, 비만군도 최대하 운동과 회복 1,3분의 값이 안정 시에 비해 유의한 차이가 있었다. 운동 직후 ST 분절은 4개 집단 모두 안정 시 값 이상으로 상승하였다. 운동 후 심박수-회복 궤도는 정상체중군과 과체중 Ⅰ, Ⅱ군의 경우 반시계 방향으로 회전하였으나, 비만군은 시계방향으로 변하였다. 심박수-회복궤도지수는 정상체중군이 +335㎶였으며, 과체중 Ⅰ군은 +467㎶, 과체중 Ⅱ군은 +354㎶, 비만군은 +215㎶로서 과체중 Ⅰ군이 가장 높고 비만군이 가장 낮았다. 연구 결과를 종합할 때 정상체중, 과체중 및 비만 여성은 최대하운동 직후에 ST 분절이 상승하는 것으로 보이며, 심박수-회복궤도로 판단할 때 비만군은 정상체중군보다 관상동맥 질환에 대한 위험도가 더 높다는 것이 확인되었다. Ko, S.K., Choi, K.S. Post-Exercise ST Segment Elevation and the Rate-Recovery Loop in Obese and Hyperlipidemic Women. Exercise Science, 13(2): 167-176, 2004. This study investigated post-exercise ST segment elevation and the rate-recovery loop in obese and hyperlipidemic women. The subjects were 25-40 years old and were classfied into four group: Normal Wesght(NW, n=12), Overweight-Normal Cholesterol (0WNC, n=12), Overweight-Hypercholesterolemic (OHC, n=11), and Obese-Hypercholesterolemic (OHC, n=11). During and after treadmill exercise, the ST segment was measured in ECG lead V5. The Rate-RLI (recovery loop index) was the mean ST segment elevation during each heartbeat in the rate-recovery loop. During exercise, the ST segment was depressed. The St segments in the OWNC, OWHC, and OHC groups were depressed below 100㎶ (1mm), which is considered diagnostic of ischemia. In the same groups, the ST segments differed significantly from the respective resting level in each group at 6-min exercise and submaximum in NW, at submaximum and 1-min recovery in OWNC, at 6-min exercise, submaximum, and 1-min recovery in OWHC, and at submaximum and l-and 3-min recovery in OHC. The rate-recovery loops were counterclockwise in NW, OWNC, and OWHC, but clockwise in OHC. The Rate-RLI was +335, +467, +354, and +215㎶ in NW, OWNC, OWHC, and OHC, respectively. There was not post-exercise St segment depression in normal or obese woman, but He ST segment was elevated above the normal level immediately after stopping exercise. The rate-recovery loop of obese women was an Intermediate loop, reflecting a higher risk of coronary artery disease than in women of normal weight.

급성하벽심근경색에서 전흉부유도 ST절 하강의 의의

정병천,배호상,곽동훈,김영태,배용학,황종현,임현주,류재근,조용근,채성철,전재은,박의현 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.2

목적 : 급성하벽심근경색증 환자에서 심전도상 흔히 동반되는 전흉부유도 ST절 하강의 의의를 알아보았다. 방법 : 심근경색후 24시간에서 48시간에 얻은 심전도를 기준으로 52명의 급성하벽심근경색증 환자를 전흉부유도에서 ST절의 하강이 있는 군과 없는 군으로 나누었으며 심도자, 관상동맥조영술, 심초음파도 및 방사성 핵종을 이용한 좌심구혈율 측정 등을 시행하였다. 결과 : 1) 좌심실확장기말압은 전흉부유도에서 ST절의 하강이 있는 경우에서 16.9±5.33mmHg로 없는 경우의 11.0±4.02mmHg보다 유의하게 높았다(p<0.05). 그러나 운동량 및 좌심구혈을은 흥부 유도상 ST절의 하강이 있는 경우 7.6±3.0 METs 및 53.9±9.1%로 없는 경우의 9.1±2.7 METs 및 54.6±9.5%보다 낮았으나 통계적 유의성은 없었다(p=0.180, p=0.823). 2) 관상동맥조영술상 전흉부 ST절의 하강이 동반된 군에서는 유의한 좌전하행지나 좌회선지의 협착이 있는 경우가 60.9% 및 57.9%로 ST절의 하강이 없는 군에서의 34.5% 및 7.7%와 비교해 좌관상동맥에 협착이 동반된 경우가 많았다(p=0.050, p=0.001). 3) 관상동맥조영술상 세 혈관질환의 빈도는 흉부유도상 ST절의 하강을 보인 23예에서 10예로 ST절 하강이 없었던 29예중 2예에 비하여 유의하게 많았고(P=0.007), 단 혈관질환의 빈도는 ST절의 하강을 보인 군에서 23예중 5예로 ST절 하강이 없었던 29예중 17예에 비하여 유의하게 적었다(P=0.002). 두 혈관질환의 경우에는 각각 8예와 10예로 양군간에 유의한 차이가 없었다. 4) 흉부유도상 ST절 하강의 빈도는 단 혈관질환 22예 중 5예에서, 두 혈관질환 18예중 8예, 세 혈관질환 12예 중 10예에서 관찰되어 협착이 있는 관상동맥의 수가 많을수록 ST절의 하강이 나타나는 빈도가 많음을 보였다(p=0.00308). 그러나 흉부유도상 나타난 ST절의 하강을 모두 합하여 구한 ST절 하강의 합은 협착이 있는 관상동맥의 수와 통계적인 유의성이 없었다. 5) 심초음파도상 좌심실 하벽의 벽운동은 ST절 하강을 보인 군에서는 akinesia가 83.3%, hypokinesia가 11.1%, 정상 벽운동이 5.6%로, ST절 하강이 없었던 군에서의 dyskinesia가 3.6%, akinesia가 39.3%, hypokinesia가 25.0%, 정상 벽운동이 32.1%와 비교하여 ST절의 하강이 있는 군에서 유의하게 벽운동의 장애가 빈번함을 보였다(p=0.03891). 그러나 좌심실전벽, 측벽 및 중격부위에서는 유의한 벽운동의 차이가 없었다. 결론 : 급성하벽심근경색증 환자의 전흉부유도에서 ST절의 하강이 동반되는 경우 다혈관 질환의 가능성이 높으며 좌심실확장기말압이 상승되었고 운동능력은 감소되어 있었다. 또한 심초음파도상 좌심실하벽의 벽운동장애도 심하였다. 따라서 전흉부 ST절의 하강을 동반한 급성하벽심근경색증 환자는 전흉부유도에 ST절 하강이 없는 경우보다 예후가 불량할 것으로 생각되며, 보다 적극적인 치료가 필요할 것으로 생각된다. The purpose of this study was to determine the significance of precordial ST segment depression appearing during acute inferior myocardial infarction and to assess the correlation of that with angiographic finding. 52 patients were allocated into two groups based on the existence of precordial ST segment depression : 23 patients with ST segment depression and 29 patients without ST segment depression. The extent of coronary artery disease as well as the prevalence of significant stenosis (≥70%) in left anterior descending artery were more frequent in patients showing precordial ST segment depression than in patients not showing them (p=0.050) and the result were similar in cases of left circumplex artery (p=0.001). On echocrdiographic examination of left ventricular (LV) wall motion, it showed more severely decreased inferior LV wall motion in patients showing precordial ST segment depression than in patients not showing them (p=0.03891) even though the other segment of LV wall motion didn't show the statistical difference between both groups. The other cardiac parameters such as LVEDP, exercise amount (METs) and ejection fraction were tend to showing bad profile in patients with precordial ST segment depression. From the above results, we could deduce that patients with precordial ST segment depression have relatively large infarction or concomitant left coronary artery disease, so they need more caution and intensive theraphy.

운동생리학 : 트레드밀 운동시 체지방에 따른 ST/HR slope 및 Duke 트레드밀 운동 점수(DTS)

김덕중(KimDuck-Jung) 한국체육학회 2003 한국체육학회지 Vol.42 No.6

The purpose of this study was to research the effects of percent body fat on aerobic exercise capacity, ST-segment depression/HR slope and Duke treadmill exercise score(DTS) during treadmill exercise in the men. Subjects were 58 men who were 40 years old, and they were classified into four groups such as control(body fat, 10~15%) group, overweight(body fat, 15~20%) group, obesity(body fat, 20~25%) group, and severe obesity(body fat, >25%) groups. HR, SBP, MVO₂ and ST segment were measured during exercise with Bruce protocol. During the graded treadmill exercise testing, ECG was recorded and analysed ST segment position at V₂ and V_5 leads and then adjusted by ST/HR slope. The treadmill exercise score was calculated as previously described: (exercise time) - (5×maximum ST segment deviation) - (4×treadmill angina). Statistical analysis was performed using analysis of oneway ANOVA. As a results, aerobic exercise capacity was significantly lower in severe obesity group than three groups. ST segment and ST/HR slope were depressed in proportion to the exercise intensity. During exercise ST/HR slope of obesity and severe obesity groups were lower than control group. Ischemic symptoms were apt to early diagnose in ST/HR slope than ST segment. Duke treadmill exercise score(DTS) was significantly lower in severe obesity group than three groups. Conclusionally, ST/HR slope was more useful method for evaluation ischemic symptom during treadmill exercise than ST segment depression. And that cardiovascular disease risk were increased in the obesity and severe obesity men.

운동생리학 : 운동종목별 선수들의 ST 분절 하강 및 QRS 벡터의 변화

윤성(YunSeong),김남익(KimNamIg) 한국체육학회 2004 한국체육학회지 Vol.43 No.1

The purpose of this study was to investigate the changes of the ST segment depression(Sr/HR slope) and QRS vector axis, QRS vector amplitude in the athletes. The subjects consisted 42 college student men, aged 19-21 years were checked by a measurement of body fat and blood pressure, and exercise stress testing. Subjects were divided into five groups such as baseball group(n=8), basketball group(n=9), soccer group(n=8), icehockey group(n=7) and rugby group(n=10). HR, SBP, MVC₂, VO₂ and ST segment were measured during exercise with Bruce protocol. During the graded treadmill exercise testing, ECG was recorded and analysed ST segment position at V₂ and V₅ leads and then adjusted by ST`/HR slope. QRS vector were measured from lead I and III in frontal plane, from lead V₂ and V₆ in horizontal plane. Statistical analysis was performed using analysis of oneway ANOVA and paired West. Results of this study were as follows; In the cardiovascular system function, resting and maximal heart rate was significantly higher in soccer and rugby group than other groups, resting MVQ₂ was significantly higher in soccer group than icehockey groups. In the ST segment, rest V₅ ST slope was significantly higher in soccer group than baseball and icehockey groups, max V₅ ST slope was significantly higher in basketball group than icehockey groups. VC₂max was significantly higher in soccer group than baseball and basketball groups, and significantly higher in rugby and icehockey group than baseball groups. Exercise time was significantly higher in soccer and rugby group than other groups. When ST/HR slope was compared with ST segment, ischemic symptoms were apt to early diagnose in ST/HR slope than ST segment. Especially, the maximal ST depression of soccer and rugby groups was -4.09μV, 0.78μV that was abnormal values indicating ischemic prognostics, but in V₅ ST/HR slope, soccer group was showed on the upsloping. In the QRS vector, frontal axis was significantly lower in rugby and icehockey group than other groups. And rest horizontal axis was significantly higher in baseball group than icehockey and basketball groups. These results indicated that the ST/HR slope and QRS vector by cardiovascular system function were increased in the soccer and rugby players.

트레드밀 운동시 ST분절의 하강을 이용한 비만 여성의 심혈관 질환 발생과 사망 가능성 예측

고성경 ( Go Seong Gyeong ) 한국운동영양학회 2002 Physical Activity and Nutrition (Phys Act Nutr) Vol.6 No.3

The purpose of this study is to prediet the morbidity and mortality by cardiovascular disease in the obese woman using ST segment depression during treadmill exercise. Subjects were 37 women who were 28-43 years old, and they were classified into three groups by BMI: Normal, Overweight, Obesity, HR, BP, rm dot V O_(2)max and ST segment level were measured during exercise with Bruce treadmill protocol. As a result, HR and SBP were increased in proportion to the exercise intensity. In the submaximal exercise. HR and SBP of Obesity were higher than Normal. But at the maximal stage, the exercise duration, reached intensity and rm dot V O_(2) of Obesity were significantly lower than Normal (p<.05). ST segment and ST/HR slop were depressed in proportion to the exercise intensity. During exercise, ST segment and ST/HR slop of Obesity were lower than Normal. Especially the maximal ST depression of Obesity was -125uN that was the abnormal values indicating ischemic prognostics. When ST/HR slop was compared with ST segment, the ischemic symptoms were apt to early diagnose in ST/HR slop. Duke treadmill score (DTS) was significantly (p<.05) lower in Obesity than Normal, but annual cardiovascular mortality (CVM) was significantly (p<.05) higher in Obesity than Normal. These results indicated that the morbidity and annual mortality by cardiovascular disease were increased in the obese women.

하부 유도의 ST분절 상승을 동반하는 급성 전벽 심근경색증의 관상동맥 조영특징과 임상적 의의

차광수,김봉근,이수훈,박태호,김무현,김영대,김종성 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.7

급성 하벽 심근경색증에서 전흉부 유도의 ST절의 상호하강이 나타난 부위에 따른 임상적 의의

이낙원,김성구 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.1

Background : The clinical implication of precordial ST-segment depression during acute inferior myocardial infarction are controversal. But it is widely accepted that ST-segment depression in precordial leads is associated with high rate of complications. There has been some reports that patients with inferior wall infarction and maximal ST-segment depression in leads V4 to V6 harbor an increased risk for hospital mortality. Method : Clinical characteristics, electrocardiograms,hemodynamic findings and coronary angiographic findings were reviewed in 34 patients with acute inferior myocardial infarction. Patients were classified into 3 types based on their pattern of ST-segment depression in precordial leads.(Group Ⅰ : no ST depression, Group Ⅱ : maximal ST depression in Ⅴ1 to Ⅴ3, Group Ⅲ : maximal ST depression in Ⅴ4 to Ⅴ6) Result : There was no significant difference in demographic data of the patients except LDH, which tended to be higher in group Ⅲ than group Ⅰ. Patients in group Ⅲ presented lower mean aortic pressure and higher pulmonary wedge pressure. The prevalence of left anterior descending coronary stenosis and three vessel disease were more frequent in group Ⅲ than group Ⅰ. Conclusion : Patients with acute inferior myocardial infarction and maximal precordial ST-segment depression in leads Ⅴ4 to Ⅴ6 had more extensive myocardial damage probably due to concomittant left anterior descending coronary artery disease.

휴통과 ST분절상승을 보이는 환자에서 급성심근경색증과 비심근경색증의 심전도 분석

류진호,김용권,소정일,허탁,민용일 대한응급의학회 2000 대한응급의학회지 Vol.11 No.4

Background: ST segment elevation in patient with chest pain was seen in acute myocardial infarction and in numerous other non-infarction syndromes. The causes of non-infarction syndrome were left ventricular hypertrophy, BER(benign early repolarization), and left bundle branch block in cardiac origin and were hyperkalemia and hyperventilation syndrome in metabolic origin and were others. Furthermore, the differentiation of electrocardiogram between acute myocardial infarction and non-infarction syndrome was very difficult. So, we compared and analysed characteristics of ST segment elevation of acute myocardial infarction and non-infarction syndrome that suggested the clue of early diagnosis of coronary artery disease. Method and Materials: We retrospectively reviewed the electrocardiogram of 961 patients with chest pain who visited the emergency center from January 1999 to December 1999. Acute myocardial infarction was diagnosed by clinical finding, electrocardiogram, cardiac enzyme, echocardiogram, and myocardial spect. Left ventricular hypertrophy, BER, and left bundle branch block in cardiac origin of non-infarction syndrome were diagnosed by electrocardiographic criteria suggested by William J. Brady. Acute myocarditis, acute pericarditis, and hyperventilation syndrome were diagnosed by clinical finding. Results: Among 961 patients with chest pain, 236(24.6%) patients manifested ST segment elevation who were diagnosed acute myocardial infarction in 162(68.6%) patients and non-infarction syndrome in 74(31.4%) patients. The causes of non-infarction syndrome in 74 patients were left ventricular hypertrophy(32:13.6%), BER(28:11.9%), left bundle branch block(11:4.7%), and others(3:1.3%). Three others were acute myocarditis, acute pericarditis, and hyperventilation syndrome. Electrocardiographic characteristics of ST segment elevation of non-infarction syndrome manifested almost same finding compared to William J. Brady' criteria. Conclusion: ST segment elevation in patient with chest pain visited emergency department was seen in acute myocarction(68.6%) and the other non-infarction syndromes(31.4%). Significant number of patients were not associated with acute myocardial infarction. Therefore, we must completely understand characteristics of ST segment elevation in acute myocardial infarction and the other non-infarction syndreomes to diagnose fatal early coronary artery disease and to avoid unnecessary thrombolytic therapy.

급성 하벽심근경색증에 동반된 ST 절의 상호 하강 ( V₁ - V₃ ) 에 대한 연구

류혜영(Hyae Young Lew),윤용선(Yong Sun Yun),강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jung Sang Song),배종화(Jong Wha Bae) 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Background: Reciprocal ST-segment depression in precordial leads is a common finding in acute inferior myocardial infarction. The responsible mechanism and the significance of this finding, however, are still controversial. Methods: From January 1991 to December 1994, 38 patients with acute inferior myocardial infarction were treated at the Department of Internal Medicine in Kyung Hee University Hospital. Clinical characteristics, serial electrocardiograms, and angiographic findings of coronary artery and left ventriculography, echocardiography were reviewed. Reciprocal ST-segment depression was defined as ST-segment depression≥1.0mm in two or more adjacent precordial leads(V₁-V₃) in patients with acute inferior myocardial infarction showing ST-segment elevation in II, III, aVF. Coronary angiography and echocardiography were performed within 24 hours from admission. In this study, angiographic distribution score was used to define the perfusion territory causing inferior ischemia. Results : 1) The summation of ST-segment elevation in II, III, aVF leads was significantly more higher in group H than group A (P<0.05). 2) However, the angiographic distribution score, peak CK levels, in-hospital complications and ejection fraction showed no difference between two groups (P>0.05). 3) There were no evidence of anterior wall motion abnormality in two groups. Conclusions: Our results suggest that the S'I'- segment depression on the precordial leads in acute myocardial infarction can be explained mainly by benign reciprocal electrical change.