Clinical Significance of Upsloping ST Depression on Resting Electrocardiogram

Introduction: Upsloping ST depression is generally not associated with myocardial ischemia, yet there have been published reports that suggest otherwise. Case History: A 34-year-old pregnant female presented with chest pain and palpitations. She was found to have supraventricular tachycardia, which resolved with intravenous adenosine. Few minutes later her ECG showed upsloping ST depression in leads V4-V6 that persisted for 1 hour after the resolution of the tachycardia. The patient was discharged in stable condition with outpatient follow-up. Conclusion: Upsloping ST depression in resting electrocardiogram may indicate cardiac ischemia in the presence of active cardiac symptoms. In the absence of ongoing symptoms however, it may be secondary to conditions other than ischemia.