ACUTE PERICARDITIS

ECG

Pericardium to pericarditis

INCIDENCE

• 90% of patients with acute pericarditis have ECG changes

Four stages< 50% of patients

• I• II• III• IV

Stage I

• Sinus tachycardia is common • ST-segment elevation in all leads except aVR and V1• Normal T-wave axis• PR-segment depression• ST segment is usually concave upward• No regional lead distributions

12 Lead ECG in stage I

All the leads except

Except V1 and aVR

Stage II

• ST segment returns to baseline and flattening of T waves occurs, typically during several days

Stage III

• T-wave inversion occurs in stage III when ST segment is normal• Sometimes with ST-segment depression

Stage IV

• ST segments and T waves return to normal• Complete normalization may require weeks to months

Variation

• Classical changes may not go through each of these phases in an individual case• PR-segment depression has been reported in about 80% of patients• PR-segment depression is one of the earliest electrocardiographic• Manifestations of pericarditis, occurring in the first few hours of

presentation and often preceding ST-segment elevation• Ventricular tachycardia and conduction abnormalities are suggestive

of myocardial involvement with ischemia(Myopericarditis)

Differential diagnosis

• Early repolarisation• Acute STEMI

Normal variant of early repolarisation

The ST-segment elevation of pericarditis can be differentiatedfrom the normal variant of early repolarization if the ratio of ST to T wave in V6 is greater than 25%

Acute STEMI

• ST elevation goes hand in hand with T wave inversion

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