Tombstone ST elevation

Overview
Tombstone ST elevation is an electrocardiographic pattern of ST segment elevation whereby the QRS complex, the ST segment and the T wave merge to form a large upright monophasic deflection called a "tombstone". This electrocardiographic pattern has been associated with poorer clinical outcomes in the setting of ST segment elevation myocardial infarction.

Criteria

 * 1) The R wave is absent or its duration is <0.04 seconds with minimal amplitude;
 * 2) The ST segment is convex upward and merges with the descending limb of the R wave or the ascending limb of the QS wave;
 * 3) The peak of the convex ST segment is higher than whatever remains of the R wave; and
 * 4) The convex ST segment merges with the ascending limb of the T wave.

Example


Source: http://pradubsukhum.com/ECG/MI/MI%20tables/Evolving%20ST%20T%20abnormalities%20in%20acute%20ST%20elevation%20MI.html