A pattern of convex ST-segment elevation that resembles a tombstone. It is associated with higher rates of complications and mortality.

Electrocardiographic Criteria

  • No recognizable R wave, or an R wave lasting ≤ 40 ms with minimal amplitude
  • Convex, upsloping ST elevation that merges with the downstroke of the R wave or with the upstroke of the QS/QR complex
  • ST-segment peak higher than the R wave. ST segment fusing with the T wave

ECG in the Tombstone ST-Elevation Pattern

Electrocardiogram with a tombstone ST-segment elevation pattern

Tombstone ST-elevation pattern. Case of acute extensive anterior wall infarction in which the QRS complex morphology resembles a tombstone. It has been described as a pattern of greater severity in MI.

References

  1. Wimalaratna HSK. “Tombstoning” of ST segment in acute myocardial infarction. Lancet. 1993;342(8869):496.
  2. Guo XH, Yap YG, Chen LJ, Huang J, et al. Correlation of coronary angiography with “tombstoning” electrocardiographic pattern in patients after acute myocardial infarction. Clin Cardiol. 2000;23(5):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(11):1316–8.