Not all ST‑T abnormalities represent ischemia or infarction. Distinguishing ischemic from non‑ischemic patterns prevents misdiagnosis and unnecessary interventions (see Ch.24 in Getting Acquainted With Ischemia and Infarction).
Pericarditis
Features:
- diffuse ST elevation
- PR depression
- absence of reciprocal changes (except aVR)
Early Repolarization
Common in younger patients. Clues:
- J‑point notching
- stable pattern over time
- no reciprocal depression
LVH With Strain
Produces:
- ST depression
- asymmetric T‑wave inversion
- voltage criteria for LVH
LBBB and Paced Rhythms
Secondary ST‑T changes complicate interpretation, but:
- concordant ST elevation
- excessive discordance may still indicate ischemia.
Related: Key Mechanism‑Based Concepts in Ischemia and Infarction