ECG: Pericarditis

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ECG OF THE WEEK ECG OF THE WEEK PROF.DR.K.H NOORUL AMEEN PROF.DR.K.H NOORUL AMEEN UNIT UNIT DR.M.JAGADEESAN DR.M.JAGADEESAN I YR PG I YR PG

Transcript of ECG: Pericarditis

Page 1: ECG: Pericarditis

ECG OF THE WEEKECG OF THE WEEK

PROF.DR.K.H NOORUL AMEEN PROF.DR.K.H NOORUL AMEEN UNITUNIT

DR.M.JAGADEESANDR.M.JAGADEESAN

I YR PGI YR PG

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A 58 year old male came with c/o A 58 year old male came with c/o breathlessness,chest pain.k/c DM, breathlessness,chest pain.k/c DM, SHT ,CKDSHT ,CKD

o/e pedal edema o/e pedal edema

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Ecg takenEcg taken

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findingsfindings

NSRNSR HR 100/minHR 100/min P wave morphology-NP wave morphology-N QRS axisQRS axis QRS-NQRS-N ST segment –concave upwards in ST segment –concave upwards in

L1,LII,avL,avF,V4-V6 ;depressed in L1,LII,avL,avF,V4-V6 ;depressed in avR&V1.avR&V1.

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PERICARDITISPERICARDITIS

– Pericarditis is a disorder caused by Pericarditis is a disorder caused by inflammation of the pericardium , the inflammation of the pericardium , the serous membrane enclosing the heart serous membrane enclosing the heart and the roots of the great blood vessels.and the roots of the great blood vessels.

– Fibrinous, aseptic inflammation Fibrinous, aseptic inflammation (predominantly lymphocytic) is the (predominantly lymphocytic) is the hallmark of uremic pericarditis.hallmark of uremic pericarditis.

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Evolution of pericarditisEvolution of pericarditis

Acute phaseAcute phase Subacute or evolving phaseSubacute or evolving phase Chronic phaseChronic phase

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Basic electrocardiographic Basic electrocardiographic effectseffects

Acute epicardial injury is reflected by Acute epicardial injury is reflected by ST segment deviation towards the ST segment deviation towards the injured surface.injured surface.

Epicardial ischemia is reflected by T Epicardial ischemia is reflected by T wave deviation away from the wave deviation away from the ischemic regionischemic region

Electrical short circuiting effect results Electrical short circuiting effect results in dimished magnitude/electric in dimished magnitude/electric alternansalternans

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Acute pericarditisAcute pericarditis   ECG changes include diffuse concave upward ST ECG changes include diffuse concave upward ST

elevation, except in leads aVR and V1 (usually elevation, except in leads aVR and V1 (usually depressed). T waves are upright in the leads with ST depressed). T waves are upright in the leads with ST elevation.elevation.

Upright T waves may be the earliest signUpright T waves may be the earliest sign Sinus tachycardia is almost invariably associated.Sinus tachycardia is almost invariably associated. The reciprocal ST segment changes or pathological Q The reciprocal ST segment changes or pathological Q

wqves of MI not seenwqves of MI not seen The most sensitive ECG change characteristic of acute The most sensitive ECG change characteristic of acute

pericarditis is ST-segment elevation, which reflects the pericarditis is ST-segment elevation, which reflects the abnormal repolarization that develops secondary to abnormal repolarization that develops secondary to pericardial inflammation.2 Depression of the PR pericardial inflammation.2 Depression of the PR segment is very specific of acute pericarditis and is segment is very specific of acute pericarditis and is attributed to subepicardial atrial injury and occurs in attributed to subepicardial atrial injury and occurs in all leads except aVR and V1. These leads may exhibit all leads except aVR and V1. These leads may exhibit PR-segment elevationPR-segment elevation. .

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Subacute or evolving phaseSubacute or evolving phase

ST segment changes tending to ST segment changes tending to become convex upward and then become convex upward and then isoelectricisoelectric

T wave also loses amplitude and T wave also loses amplitude and becomes isoelectricbecomes isoelectric

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chronicchronic

It is characterised byIt is characterised by Low to inverted T waves in most Low to inverted T waves in most

leadsleads Diminished amplitude of all the ecg Diminished amplitude of all the ecg

detectionsdetections Potential elctrical alternans best seen Potential elctrical alternans best seen

in midprecordial leadsin midprecordial leads

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ChronicChronic

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DD –ST elevationDD –ST elevation

MIMI ACUTE PERICARDITISACUTE PERICARDITIS LVHLVH VENTRICULAR ANEURYSMVENTRICULAR ANEURYSM ERSERS HYPOTHERMIAHYPOTHERMIA

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Single electrocardiographic complexes comparing Single electrocardiographic complexes comparing (left) acute pericarditis, (center) early repolarization (left) acute pericarditis, (center) early repolarization and (right) injury pattern of acute myocardial and (right) injury pattern of acute myocardial infarction. The degree of ST-segment elevation is infarction. The degree of ST-segment elevation is greater in the pericarditis complex than in the early greater in the pericarditis complex than in the early repolarization complex. Important findings of acute repolarization complex. Important findings of acute infarction include the presence of Q waves and a infarction include the presence of Q waves and a more convex upward ST segment, both of which are more convex upward ST segment, both of which are present in the right complex. present in the right complex.

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ECG finding Acute pericarditisMyocardial infarction

Early repolarization

ST-segment shape Concave upward Convex upward Concave upward

Q waves Absent Present Absent

Reciprocal ST-segment changes Absent Present Absent

Location of ST-segment elevation Limb and precordial leads

Area of involved artery

Precordial leads

ST/T ratio in lead V6* >0.25 N/A <0.25

Loss of R-wave voltage Absent Present Absent

PR-segment depression Present Absent Absent

 

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CAUSESCAUSES ACUTE RHEUMATIC FEVERACUTE RHEUMATIC FEVER VIRALVIRAL UREMIA RELATEDUREMIA RELATED Late start of, or inadequate hemodialysis Late start of, or inadequate hemodialysis 

Retained uremic toxins  Retained uremic toxins  Loss of residual renal function Loss of residual renal function

DRESSLERDRESSLER TBTB MYXOEDEMAMYXOEDEMA MALIGNANCYMALIGNANCY Side effect of some medications, Side effect of some medications,

e.g. isoniazid, cyclosporine, hydralazine, e.g. isoniazid, cyclosporine, hydralazine, warfarinwarfarin, , and heparin and heparin

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AcuteAcute