Agonal ST Segment Elevation

Report:

Supraventricular rhythm of uncertain origin

Sinus rhythm, with sinus arrests

Probable junctional rhythm

Progressive ST segment elevation

Asystole

Comment:

Initial ST depression, followed by elevation, is quite common terminal event. Presumably, subendocardial ischæmia becomes transmural. QRS complex itself widens in this situation and it may be difficult to delineate it from the elevated ST segment. Fortunately it matters little here, in contrast to a similar conundrum in acute myocardial infarction.

The above patient was really unlucky. His peritonitis from bowel perforation was cleaned up at surgery, but day later the colostomy stump, with some fæces inside, fell into the abdomen and septic shock ensued. As the strip shows, he was not resuscitated. His initial ST segment depression was not recorded

Another example is shown below (Fig 185a), and yet another (Fig 185b) on the next two pages. I used to collect them in my younger days, because ICU is a setting for monitored, elective death. This stopped long ago: there were too many, and their medical significance is slight.

185a. Different patient; ST depression, then elevation.

185b. Different patient. Initial ST segment depression. 185c. Same patient as 185b; progressive ST elevation

186. Breathless and hypotensive 39 year old man with extensive leg and thigh thrombophlebitis. The CXR is clear, as is the diagnosis.