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23-13: Acute Pericarditis

Maite A. Huis in ‘t Veld; Amal Mattu; R. Jason Thurman

ECG Findings

  • Diffuse, concave upward ST elevation

  • ST elevation typically greater in lead II than lead III

  • PR depression in multiple leads (in viral pericarditis)

  • PR elevation and ST depression in lead aVR common (although not specific for pericarditis)

  • T-wave flattening or inversion in late stages

  • Absence of reciprocal changes (with exception of aVR and V1)

Pearls

  1. Inflammation of the pericardium can cause pericarditis. As the pericardium is circumferential, the ECG changes are most often diffuse.

  2. Presence of significant Q waves or reciprocal changes in any leads (with the exception of aVR or V1) should prompt consideration of acute or old MI.

  3. Pericarditis may be focal, resulting in regional rather than diffuse ECG changes.

FIGURE 23.13A

Acute Pericarditis. (ECG contributor: James V. Ritchie, MD.)

An E C G tracing with 12 leads from a patient with acute pericarditis. The leads show irregular and sharp fluctuations as peaks and dips.
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FIGURE 23.13B

ST elevation in noncontiguous leads I and II (arrows) with PR depression (arrowhead). No pathologic Q waves or reciprocal changes are present.

An E C G tracing with two leads from a patient with acute pericarditis.
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