ECG in acute pericarditis

Q: ST elevation on EKG in acute pericarditis is usually? (select one)

A) concave-up

B) convex-up

Answer: A

Although not a confirmed science but a great tool to remember that in acute pericarditis the ST elevation is usually present in all the leads in a concave-up manner. In contrast, ST elevation in myocardial infarction (MI) is usually limited to the affected area in a convex-up manner.

EKG in acute pericarditis mostly evolves through four stages.

Stage 1 (hours to days) - widespread ST elevation (typically concave up) with reciprocal ST depression in leads aVR and V1. There is also frequently an atrial current of injury, reflected by elevation of the PR segment in lead aVR and depression of the PR segment in other limb leads and in the left chest leads, primarily V5 and V6. Thus, the PR and ST segments typically change in opposite directions. PR segment deviation is highly specific, though less sensitive.

Stage 2 (first week) - normalization of the ST and PR segments.

Stage 3 (afterward) - development of diffuse T-wave inversions.

Stage 4 - normalization of the EKG.

#cardiology

References:

1. Sarda AK, Thute P. Importance of ECG in the Diagnosis of Acute Pericarditis and Myocardial Infarction: A Review Article. Cureus. 2022 Oct 24;14(10):e30633. doi: 10.7759/cureus.30633. PMID: 36426313; PMCID: PMC9683083.

2. Liu YL, Lin CS, Cheng CC, Lin C. A Deep Learning Algorithm for Detecting Acute Pericarditis by Electrocardiogram. J Pers Med. 2022 Jul 15;12(7):1150. doi: 10.3390/jpm12071150. PMID: 35887647; PMCID: PMC9324403.

3. Masek KP, Levis JT. ECG diagnosis: acute pericarditis. Perm J. 2013 Fall;17(4):e146. doi: 10.7812/TPP/13-044. PMID: 24361030; PMCID: PMC3854820.