Tombstone ECG or Tombstoning EKG, as the name suggests takes the shape of a tombstone. It’s a ST elevation Myocardial Infarction (STEMI) with prominent ST elevation indicating severe myocardial damage. It may be associated with left ventricular dysfunction and conduction defects. Usually the prognosis is poor and hospital complications are significant.
Tombstone ST elevation is easy to recognize and not rare. Approximately 10-26.1% of the patients. Commonly seen in anterior/ anterolateral infarcts. However it may be observed in posterior infarcts too.
Tombstone ECG Characterisitcs:
Tombstone ECG is characterized by marked elevation of ‘J’ point along with the T wave giving the appearance of a Tombstone. The ST segment is convex upwards and the ST elevation is often higher than the nearby R waves.
One must look for J point to avoid confusing Tombstone ECG with tall tented T waves. ‘J’ point is the actual measurement of ST elevation in a lead. In the above ECG ,the J point itself is elevated upto 4 to 6 mm and thus ST segment elevation is huge.Another differentiating point is upward convexity. This indicates severe underlying ischemic damage to heart musculature.
Below is a tall tended T wave ECG found in Hyperklemia, for comparision:
Here in V leads we see very tall T waves. But the ‘J’ Point is just in the baseline and the ST convexity is clearly downward.