Tombstone ST-segment elevation

Tombstone ST-segment elevation

ST-segment elevation – Resemble Tombstone – Appears like Tombstone

Tombstone ST-segment elevation
Tombstone ST-segment elevation seen in acute anterior wall myocardial infarction

Ann Noninvasive Electrocardiol. 2020 Mar; 25(2): e12725. Published online 2019 Nov 10. doi: 10.1111/anec.12725

Ann Noninvasive Electrocardiol. 2020 Mar; 25(2): e12725. Published online 2019 Nov 10. doi: 10.1111/anec.12725
  • Tombstoning ST‐segment elevation (Tomb‐ST) usually have poor in‐hospital and short‐term survival rates.
  • Tombstoning ST-segment elevation (Tomb-ST) in anterior precordial leads is one such morphologic variant that may indicate massive myocardial damage 
  • Tombstone ST-segment elevation is one such morphological variant observed in early phase of acute MI suggesting extensive myocardial damage
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The term ‘tombstone ECG’ was coined by Wilmalaratna.

The criteria for tombstone were modified by Guo et al.

ECG characteristics for tombstone STEMI are as follows:

  • i. Absent R wave or an R wave duration of <0.04 second with minimal amplitude.
  • ii. Convex upward ST segment merging with descending R or the ascending QS/QR
  • iii. Peak of ST-segment is higher than the R wave
  • iv. ST-segment merges with the T wave

Therapeutic significance of Tombstone ST-segment elevation

Tombstone STEMI is usually associated with poor prognosis due to

  1. Extremely rapid myocardial damage
  2. Poor collateral flow
  3. Diffuse coronary artery disease
  4. Inadequate myocardial protection effect of pre-infarct angina
  5. Elevation of wall tension
  6. Myocardial recovery is shown to be limited despite revascularization
  7. Higher incidence of unsuccessful PCI
Tombstone ST-segment elevation
Tombstone ST-segment elevation
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