![]() In patients with baseline abnormalities, one approach is to consider a 1-mm change from baseline as significant. Definitions of a significant ST-segment shift are also difficult when there is baseline ST-segment depression or left ventricular hypertrophy with strain. There are baseline abnormalities that make interpretation of the ST segment difficult or impossible for example, both left bundle branch block and Wolff-Parkinson-White syndrome alter repolarization, which can lead to nonischemic ST-segment changes. The depth of ST-segment depression has been used as a measure of the severity of myocardial ischemia. T-wave inversions and R-wave changes are also associated with myocardial ischemia, although numerous factors (particularly electrolyte changes) can lead to these findings. PMID 16032622.Changes indicative of myocardial ischemia are horizontal or downsloping ST-segment depression or ST segment elevation of at least 1 mm (0.1 mV). The American Journal of Emergency Medicine. "Electrocardiographic ST-segment elevation in the trauma patient: acute myocardial infarction vs myocardial contusion".
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