Subtle ST elevation is common in clinical practice, is not addressed by the guidelines, and is usually associated with an OMI. It is defined as J-point elevation between 0.1 and 1 mm, and the ECG usually shows hyperacute T waves or reciprocal changes that can help with the diagnosis.

Electrocardiographic Criteria

  • ST-segment elevation between 0.1 and 1 mm

ECG in Subtle ST Elevation

Electrocardiogram showing subtle ST-segment elevation

Subtle ST elevation. Patient with chest pain and an ECG showing subtle ST elevation in the inferior wall (< 1 mm), along with ST depression in aVL. The tracing is consistent with occlusion myocardial infarction, even though it does not reach the 1 mm cutoff suggested by the guidelines.

References

  1. Martí Sánchez D, Mestre JL, Salido L, Esteban MJ, et al. Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction. Am Heart J. 2014;168(6):884–90.
  2. Scheffer MK, De Marchi MFN, de Alencar Neto JN, Felicioni SP. Eletrocardiograma de A a Z. São Paulo: Manole, 2024.