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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Tombstone ST elevation

Introduction

Overview

Overview

Tombstone ST elevation is an electrocardiographic pattern of ST segment elevation whereby the QRS complex, the ST segment and the T wave merge to form a large upright monophasic deflection called a “tombstone”[1][2][3][4]. This electrocardiographic pattern has been associated with poorer clinical outcomes in the setting of ST segment elevation myocardial infarction.

Criteria

Criteria

  1. The R wave is absent or its duration is <0.04 seconds with minimal amplitude;
  2. The ST segment is convex upward and merges with the descending limb of the R wave or the ascending limb of the QS wave;
  3. The peak of the convex ST segment is higher than whatever remains of the R wave; and
  4. The convex ST segment merges with the ascending limb of the T wave.
Example

Example

Source: http://pradubsukhum.com/ECG/MI/MI%20tables/Evolving%20ST%20T%20abnormalities%20in%20acute%20ST%20elevation%20MI.html

References

References

  1. ↑ Wimalaratna HS. “Tombstoning” of ST segment in acute myocardial infarction. Lancet 1993; 342 (8869): 496.
  2. ↑ Guo XH, Yap YG, Chen LJ, et al. Correlation of coronary angiography with “tombstoning” electrocardiographic pattern in patients after acute myocardial infarction. Clin Cardiol 2000; 23: 347-52.
  3. ↑ Balci B, Yesildag O. Correlation between clinical findings and the “tombstoning” electrocardiographic pattern in patients with anterior wall acute myocardial infarction. Am J Cardiol 2003; 92: 1316-8.
  4. ↑ Birnbaum Y, Sclarovsky S. “Tombstoning” of ST segment in acute myocardial infarction. Lancet 1993; 342: 1494.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]