non-specific ST-T wave changes

[Just Plain Ruff]

Ok, I'm reviewing some old charts today and I came across this gem.

New EKG done today, Old EKG done 14 months ago.

The reading reads out as this.

His electrocardiogram showed a normal sinus rhythm with a rate of 75, first degree AV block, non-specific ST-T wave changes. I do have an old EKG to compare it with from 03/03/2009 and this is unchanged from previously done.

Ok my question is this.

IF the EKG is unchanged from 14 months ago then how can he have non-specific st-t wave changes??? If he has only two ekg's to review the new one and the old one and they are unchanged - where is he getting the non-specific st-t wave changes at?

I don't understand it.

I'm at a loss to describe it.

I might preface this that this is not a cardiologist reading these two EKG's.

[chbare]

Hey Ruff, can you attach copies and give out any history? It's hard to say as many things can cause non specific ST changes and this is not an uncommon finding. Problems such as acid/base imbalances, drug effects, electrolyte imbalances, endocrine problems and an array of pulmonary & cardiovascular problems can cause non specific changes.

Take care,

chbare.

[Just Plain Ruff]

Hey Ruff, can you attach copies and give out any history? It's hard to say as many things can cause non specific ST changes and this is not an uncommon finding. Problems such as acid/base imbalances, drug effects, electrolyte imbalances, endocrine problems and an array of pulmonary & cardiovascular problems can cause non specific changes.

Take care,

chbare.

Sadly I do not have any copies of the 12 leads.

What struck me as strange is that if the Dr. is saying there are non-specific changes and then goes to the next step and saying that there are no changes from previous EKG doesn't that seem strange?

[jonas salk]

What I can imagine is that both 12 leads showed the same ST changes, that whatever s/he was seeing in the current 12 lead were present in 2009.

[Just Plain Ruff]

What I can imagine is that both 12 leads showed the same ST changes, that whatever s/he was seeing in the current 12 lead were present in 2009.

True true true but.....

The physician had two EKG's. EKG 1 - 1 year old EKG 2 - very recent

How can the physician say non-specific changes when the ekgs show no change from previous to new. Isn't that contradictory?

Not trying to be argumentative but I am at a loss with this physicians thought process. I guess I could go ask her but I don't know her.

[chbare]

True true true but.....

The physician had two EKG's. EKG 1 - 1 year old EKG 2 - very recent

How can the physician say non-specific changes when the ekgs show no change from previous to new. Isn't that contradictory?

Not trying to be argumentative but I am at a loss with this physicians thought process. I guess I could go ask her but I don't know her.

I think the physician was saying the ECG had non-specific changes when compared to a "normal" generic ECG. I do not think it needs to be any harder than that simple explanation. FOr example, if a patient is in atrial fibrillation a year ago and they are in atrial fibrillation today, we still call it atrial fibrillation even though nothing has changed. Same concept applies here.

Take care,

chbare.

[tskstorm]

I think the physician was saying the ECG had non-specific changes when compared to a "normal" generic ECG. I do not think it needs to be any harder than that simple explanation. FOr example, if a patient is in atrial fibrillation a year ago and they are in atrial fibrillation today, we still call it atrial fibrillation even though nothing has changed. Same concept applies here.

Take care,

chbare.

I agree. Simple language issue.

[FL_Medic]

Just for fun, here ya go. I know it doesn't answer your question, but the topic made me think of it, and I figured I would share below. To answer your question, "non-specific ST-T changes" is something commonly used by the non-EP physicians out there (which is most). It is similar to an EMT telling you they got 130/palp after listening for a BP.... It isn't actually what the patient has, but it isn't necessarily a lie either. Explain to me how you could ever have a "non-specific ST-T wave change"? The change is SPECIFIC, but the etiology may be unknown.

ST-Elevation:

E - Electrolytes (hyperkalemia)


L - LBBB


E - Early repolarization (high take off)


V - Ventricular hypertrophy (LVH)


A - Aneurysm


T - Treatment (eg pericardiocentesis)


I - Injury (AMI, contusion)


O - Osborne waves (hypothermia)


N - Non-occlusive vasospasm

ST-Depression:

D - Drooping valve (MVP)


E - Enlargement of LV with strain


P - Potassium loss (hypokalemia)


R - Reciprocal ST- depression (in I/W AMI)


E - Embolism in lungs (pulmonary embolism)

S - Subendocardial ischemia


S - Subendocardial infarct


E - Encephalon hemorrhage (intracranial hemorrhage)


D - Dilated cardiomyopathy

Inverted T-waves:

I - Ischemia


N - Normality [esp. young, black]


V - Ventricular hypertrophy


E - Ectopic foci [eg calcified plaques]

R - RBBB, LBBB


T - Treatments [digoxin]

"Nonspecific" ST and T-Wave Changes

CHARLES K. FRIEDBERG M.D.1 ALBERT ZAGER M.D.1

1 From the Division of Cardiology, Department of Medicine, The Mount Sinai Hospital, New York, New York.

A study was made of 1,000 consecutive adult in-patient electrocardiograms to determine the possibility of making a more precise diagnosis than "nonspecific ST and T-wave changes." More than 50 per cent (209) of the 410 abnormal electrocardiograms (exclusive of arrhythmias) were characterized by nonspecific depression of ST segment or T wave inversion, or both.

These 209 cases comprised four groups: (1) 46 patients (22 per cent) had received digitalis, which could account for the ST-T changes; (2) 57 patients (27 per cent) had had an acute episode of cardiac pain within 5 days prior to the electrocardiogram; (3) 57 patients (27 per cent) had had no recent cardiac pain but suffered from some disease that could be regarded as a possible cause for the ST-T changes; and (4) 49 patients (24 per cent) had no apparent cause for the electrocardiographic changes. In the last group, in contrast with the others, the ST-segment depression was less than 0.5 mm. and the T-wave inversion less than 1 mm.

In patients with recent cardiac pain, as contrasted with those without such pain, the electrocardiograms were characterized by a combination of ST depression and T-wave inversion, with a depth of more than mm. of the ST depression and more than 1 mm. inversion of the T wave, by isolated T-wave inversion of more than 2 mm. and especially by more than 5 mm. in the midprecordial leads, and by an ischemic contour of the ST segment that is depressed more than mm.

There was no definite difference in the electrocardiographic findings in the patients with recent cardiac pain of less than hour and those with recent cardiac pain of more than hour when the cases with transmural infarction (Q-wave changes) were excluded. This is compatible with the concept that the electrocardiogram usually does not distinguish between subendoeardial ischemia and subendocardial necrosis. The latter differentiation would depend on multiple clinical and laboratory findings.

Differential for Non-specific ST-T wave changes

Hyperthyroid status

Hyperthyroidism (Graves disease)

Postural hypotension

Hypothyroidism (myxedema)

Addison's disease (chronic adrenal ins)

Hypertension, malignant

Thyrotoxic crisis

Complete heart block

Hypertension, accelerated

Thyrotoxic heart disease

Cushing's disease/Syndrome

Early repolarization EKG syndrome

Adrenocorticoid Deficiency

Hypertension

One more source from Google:

Nonspecific ST-T wave abnormalities are very common and may be seen in any limb or precordial lead of the electrocardiogram. The changes may be seen in all of the limb and precordial leads (diffuse changes), or they may be present only in the inferior, lateral, or anterior leads.

The types of abnormalities are varied and include straightening of the ST segment, ST segment depression or elevation, flattening of the T wave, or T wave inversion (figure 1). Causes of these changes include:

Electrolyte abnormalities

Post-cardiac surgical state

Anemia

Fever

Acidosis or alkalosis

Catecholamines

Drugs

Acute abdominal process

Endocrine abnormalities

Metabolic changes

Cerebrovascular accidents

Diseases such as myocarditis, pericarditis, cardiomyopathy, pulmonary emboli, infections, amyloidosis, systemic diseases, lung diseases

Abnormal T waves and ST segments may also be seen in healthy individuals, including well trained athletes.

Edited June 14, 2010 by FL_Medic