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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)


  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.


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


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

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