Acute Pericarditis: Electrocardiogram

Jason Mefford, MD and Shannon L Toohey, MD

doi:https://doi.org/10.21980/J8059Q

Acute Pericarditis: Electrocardiogram

Jason Mefford, MD^* and Shannon L Toohey, MD^*

^*University of California, Irvine, Department of Emergency Medicine, Orange, CA

Correspondence should be addressed to Shannon Toohey, MD at stoohey@uci.edu

DOI: https://doi.org/10.21980/J8059QIssue 1:1

Cardiology/Vascular Visual EM

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HPI:

A 22 year-old male presented to the emergency department with a chief complaint of retrosternal chest pain that started yesterday. He described the pain as a constant, sharp and pleuritic. The pain was worsened by lying flat, and improves with leaning forward. He reported having a sore throat and other cold symptoms earlier in the week. The patient’s exam was notable for a faint pericardial friction rub. A bedside echocardiogram demonstrated normal cardiac function without pericardial effusion. The patient’s ECG is shown.

Significant findings:

The ECG shows diffuse ST- elevation. The patient also has mild PR-depression, most notably in the inferior and lateral leads. The patient also has minimal PR elevation in lead aVR. The patient was diagnosed with acute pericarditis (ECG stage 1).

Discussion:

Pericarditis is inflammation or infection of the pericardial sac. There most common etiologies are viral or idiopathic^1,2. While it is rarely fatal, acute pericarditis can cause severe, disabling pain². Furthermore, concomitant myocarditis can cause significant morbidity and mortality. Classic ECG findings include diffuse ST-elevations and PR- segment depression, without reciprocal ST-segment depression (as shown in this image). The ECG of pericarditis may move through various stages when followed over time^1,2. These include stage 1: diffuse ST-elevations with concave-upwards contour, PR- depressions (most common in II, aVF, V4-6); stage 2: ST segments become isoelectric and T waves flatten; stage 3: symmetric T wave inversion throughout ECG; and stage 4: ECG normalization². These ECG changes have variable sensitivity and specificity depending on the stage, with less than 50% of patients progressing through the classic stages².

Topics:

Cardiology, Cards, ECG, ST elevation, acute pericarditis, abnormal ECG, PR depression

References:

Colletti JE, Tabas JA. Cardiovascular disorders in emergency medicine. In: Schofer JM, Mattu A, Kessler C, Lu LN, Parker T, Rogers R, et al. eds. A Focused Review of the Core Curriculum. 2^nd Milwaukee, WI: American Academy of Emergency Medicine Resident and Student Association; 2015:237-242.
Mattu A, Martinez JP. Pericarditis, pericardial tamponade, and myocarditis. In: Adams JG, Barton ED, Collings JL, DeBlieux PM, GIsondi MA, Nadel ES, eds. Emergency Medicine: Clinical Essentials. 2^nd Philadelphia, PA: Elsevier; 2013:514-523.