ST elevation during treadmill test

Usual ischemic response on a treadmill ECG is ST segment depression. But sometimes ST segment elevation may also be noted. ST segment depression seen during treadmill test (TMT) does not have localizing value regarding the territory of ischemia. But ST elevation is thought to have localizing value. ST segment elevation occurring in leads with Q waves was initially thought not to represent ischemia and rather a manifestation of a dyskinetic segment. But now ST segment elevation in leads with Q waves is thought to be a sign of viability in the infarct territory. In this series, there is ST segment elevation in the inferior leads with Q waves as well as ST depression in I and aVL, persisting well into recovery. In some cases during treadmill test, ST segment depression does not appear during exercise, but only in recovery. In still others, ST segment depression is mild and horizontal during the exercise, but worsens in recovery, often becoming downsloping. All these changes are quite significant and are considered indications for coronary angiography.

TMT stage 1 showing ST elevation in inferior leads and ST depression in lead I and II

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TMT stage 2 showing ST elevation in inferior leads and ST depression in lead I and II

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TMT stage 3 showing ST elevation in inferior leads and ST depression in lead I and II

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TMT recovery at 2 minutes showing ST elevation in inferior leads and mild ST depression in lead I and II

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TMT recovery at 6 minutes showing ST elevation in inferior leads and mild ST depression in lead I and II

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