These two leads, ST depression will be seen because they are the opposing leads of the cardiac axis. The ST-segment elevations in Panel A appear reassuring; indeed, this smooth, upwardly concave morphology is classically associated with more benign, nonacute coronary syndrome etiologies such as early repolarization pattern, left ventricular hypertrophy or pericarditis. How to distinguish Pericarditis from STEMI on ECG: Three questions: 1. Pericarditis in acute myocardial infarction: characterization and clinical significance. However, look closely at aVL: there is actually a bit of ST depression here. Sinus tachycardia is also common in acute pericarditis due to pain and/or pericardial effusion. Early repolarization, unlike pericarditis, is a benign ECG finding that should not be associated with any symptoms. Acute pericarditis begins suddenly but doesn't last longer than three weeks. It may be difficult to tell the difference between acute pericarditis and pain due to a heart attack. PR segment depression is highly suggestive of pericarditis. Sinus. 2016; 34(2):149-154. Future episodes can occur. Am Heart J 1989; 117:86. : Specialty: Cardiology: Symptoms: Sharp chest pain, better sitting up and worse with lying down, fever: Complications: Cardiac tamponade, myocarditis, constrictive pericarditis: Usual onset: Typically sudden: Duration Normal QRS. Figure 7.1 The shape of the ST-segment elevation.. Pericarditis; An ECG showing pericarditis. Tofler GH, Muller JE, Stone PH, et al. Moreover, the pain in acute pericarditis may also, as in STEMI, radiate to the neck, shoulders or back. ST-segment Elevation in Conditions Other than Acute Myocardial Infarction. That should not happen with pericarditis or with early repol, especially when there is J-wave notching. Recurrent pericarditis occurs about four to six weeks after an episode of acute pericarditis with no symptoms in between. Widespread concave ST elevation and PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6). Incidence and Prognosis of Pericarditis After ST-Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey 2000 to 2013 Registry Database). Differentiating acute pericarditis and acute ST elevation myocardial infarction (STEMI) The retrosternal chest pain caused by acute pericarditis may be very similar to that seen in patients with STEMI. Reciprocal ST depression and PR elevation in lead aVR (± V1). The ST segment elevation in early repolarization resolves when the person exercises. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Is there convex up or horizontal ST elevation? Is there ST depression in a lead other than aVR or V1? If YES, it’s a STEMI. If YES, it’s a STEMI. Am J Emerg Med. Note the ST elevation in multiple leads with slight reciprocal ST depression in aVR. In two weeks after pericarditis, there will be upward concave ST elevation, positive T wave, and PR depression. 2. N Engl J Med 2003;349:2128-35. The major clinical signs and symptoms include ECG changes with recent widespread ST elevation or PR depression, pericardial friction rub, sharp or stabbing chest pain, fatigue, breathlessness, and palpitations. 13 Patients with pericarditis often present with pericardial effusion. Lador A, Hasdai D, Mager A, et al. If … 3. QTc 375. Diffuse, convex (up) ST segment elevations with or without PR-segment depressions can be seen in both pericarditis or ST-segment Elevation Myocardial Infarction (STEMI), particularly if the patient has a wraparound LAD which supplies the inferior wall. R wave in most cases will be unaltered. ST elevation in all leads that is not inconsistent with early repol or pericarditis, especially since there is J-wave notching (in lead aVL). 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