[Medical Q&A] Does ST-T changes on the electrocardiogram mean coronary heart disease?

Planner: Chinese Medical Association

Reviewer: Fan Yifan, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

ST-T changes refer to abnormal changes in the ST segment and T wave on the electrocardiogram. The ST segment and T wave represent the potential changes during the repolarization of ventricular myocytes. Under normal circumstances, the ST segment is mostly located on the isoelectric line, and the T wave is usually in the same direction as the main wave of the QRS group. When the ST segment is elevated or depressed, and the T wave is high, flat, bidirectional or inverted, it is an ST-T change. ST-T changes may be caused by a variety of factors. Heart lesions, such as coronary heart disease, myocardial hypertrophy, myocarditis, valvular heart disease, etc., can lead to ST-T changes. In addition, diseases other than the heart may also cause ST-T changes, such as cerebrovascular accidents, endocrine diseases, electrolyte disorders (such as hypokalemia, hypomagnesemia), drug effects (such as certain antiarrhythmic drugs, digitalis, etc.), and the influence of physiological factors such as autonomic dysfunction, excessive fatigue, and mental stress. It can be seen that ST-T changes are not an exclusive sign of coronary heart disease, and there may be a variety of causes behind them.

Although ST-T changes are not specific to coronary heart disease, coronary heart disease is indeed an important cause of ST-T changes. In patients with coronary heart disease, due to insufficient blood supply to the coronary arteries, myocardial cells may suffer from ischemia and hypoxia, which manifests as ST-T changes on the electrocardiogram. Especially when patients have angina pectoris or acute myocardial infarction, ST-T changes on the electrocardiogram often have important diagnostic value.

When ST-T changes appear on the electrocardiogram, patients do not need to panic too much. The correct approach is to consult a professional doctor in time for a detailed interview and physical examination. The doctor will make a comprehensive judgment and analysis based on the patient's symptoms (such as chest pain, chest tightness, palpitations, dyspnea, etc.), medical history (such as hypertension, diabetes, hyperlipidemia and other risk factors), and other test results (such as cardiac ultrasound, myocardial necrosis marker detection, coronary artery CTA, coronary angiography, etc.). If coronary heart disease is highly suspected, the doctor may recommend further examination to clarify the condition of the coronary arteries. If coronary heart disease is ruled out, it is necessary to actively look for other possible causes and give corresponding treatment.