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Postgraduate Medical Journal 2004;80:276
© 2004 Fellowship of Postgraduate Medicine

IMAGES IN MEDICINE

"Tombstone" ST segment elevation of acute myocardial infarction

M K Sinha , D Dasgupta , J P Lyons

Department of Cardiology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH, UK; msinha@sghms.ac.uk

Keywords: ST segment elevation; acute myocardial infarction

The first 150 words of the full text of this article appear below.

An 82 year old hypertensive woman presented to the emergency department with a two hour history of retrosternal chest pain. She had no previous history of angina or myocardial infarction. Her initial 12 lead electrocardiogram (ECG) showed massive "tombstone" ST elevation in the anterolateral leads (fig 1Go) and she was thrombolysed with tenecteplase. She developed torsades de pointes during reperfusion but otherwise made an unremarkable recovery (fig 2Go). She had a troponin T rise of 6.5 ng/l.


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  		Figure 1 ECG before thrombolysis.

 

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  		Figure 2 ECG after thrombolysis.

 
Tombstone ST elevation is an unusual morphological ECG appearance of acute myocardial infarction. The ST segment is convexed upwards and the peak of the convexed ST segment is often higher than the preceding R wave, which is less than 0.04 s and small in amplitude. This type of tombstone pattern is associated with reperfusion polymorphous ventricular tachyarrhythmias1 and is thought to represent extensive and rapid . . . [Full text of this article]






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