Q. Can you show Downsloping ST-Segment?

The long term follow-up information suggests that patients whose ST depression evolves to downsloping have more severe disease than those that do not. Recently it has been reported that downsloping ST depression indicates that a larger area of myocardium is involved and that when the subepicardial muscle as well as the subendocardium is also ischaemic, is usually due to mutivessel disease. Downsloping pattern in V3 and V4 may be due to the additive effects of anterior wall subendocardial ischaemia superimposed on transmural posterior wall ischaemia. Anterior transmural ischaemia results in ST elevation and would expect transmural posterior wall ischaemia would produce a vector in the same direction as the anterior subendocardial ischaemia process. Thus downsloping ST depression in V3 and V4 probably represents more severe ischaemia than horizontal. It may be a marker for multivessel disease.