ST segment elevation with an upward convexity is usually benign, especially when seen in healthy, asymptomatic individuals.
ST segment elevation with a downward concavity is more likely to be due to acute coronary syndrome.
Although ST elevation with an upward concavity and J-point notching often reflects a normal variant, this is only true if the patient is asymptomatic. The same ST pattern in a patient with chest pain is due to acute coronary syndrome until proven otherwise.
Image source: Medinfo-UFL
J-point elevation, ST-segment elevation, and T-wave changes are reported with high frequency in athletes.
When examining the ST segment, focus on elevations or depressions 0.06 seconds after the J-point (since the ST segment can at times be sloping).
References:
ECG Web Brain is a useful online and iPad/iPod reference (no longer free, $15 per year).
Sport Medicine
University of Maryland-EKG
ST-Segment Elevation in Conditions Other Than Acute Myocardial Infarction - NEJM - 11/03
EKGs Showing Normal ST-Segment Elevation and Normal Variants
EKGs Showing ST-Segment Elevation in Various Conditions
Other free Palm programs from P-brain
