Electrocardiographic ST segment depression

Traditionally, ST segment depression has been associated with acute coronar y syndromes; this electrocardiographic pattern may also be found in patient s with nonischemic events, such as left bundle branch block (LBBB), left ve ntricular hypertrophy (LVH), and those with therapeutic digitalis levels. U sing the ECG as an adjunct in distinguishing those patients with acute coro nary syndromes from those with more "benign," nonacute causes of STSD will obviously lead to divergent treatment and management plans. The following c ases illustrate the use the ECG in patients presenting with chest pain and electrocardiographic ST segment depression attributable to an ACS, LVH, LBB B, or digitalis. (Am J Emerg Med 2001;19:303-309. Copyright (C) 2001 by W.B . Saunders Company).