HIV induced pericarditis electrocardiogram

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ramyar Ghandriz MD [2]

Overview

Acute pericarditis can mimic myocardial infarction (STEMI) signs and electrocardiogram and present with chest pain and cardiac enzyme (bio-marker) elevation the differentiation is made by specific features.

Electrocardiogram

Acute pericarditis can mimic myocardial infarction (STEMI) signs and electrocardiogram and present with chest pain and cardiac enzyme (bio-marker) elevation.^[1]
IF pericarditis does not follow myocarditis and vice versa, the differentiation is made as following:^[2]^[3]^[4]
- Morphology:
  - Start of ST-elevation: in acute pericarditis begins at the J point(termination of depolarization junction)
  - STEMI patients present a dome-shaped ST-elevation that can be more than 5MM in height.
- Distribution:
  - Pericarditis shows a non-specific ST-elevation pattern while STEMI shows specific changes based on the infarction location.
- Reciprocal changes:
  - STEMI is often associated with reciprocal changes.
  - Pericarditis reciprocal changes are just seen in leads aVR and V1.
- Concurrent ST and T wave changes:
  - Pericarditis is not followed by ST-segment elevation and T wave.
  - Those changes are pretty common in STEMI.
- PR segment:
  - Pericarditis shows PR elevation in aVR with PR depression in other leads because of atrial injury.
  - STEMI does not show such changes.
- Other signs:
  - Hyperacute T waves
  - New pathologic Q waves
  - QT prolongation
  - These signs are rarely seen in acute pericarditis
Shown below is an EKG with the presence of micro-voltage and electrical alternans suggesting pericardial effusion and cardiac tamponade.

Copyleft image obtained courtesy of ECGpedia ^[5]

References

↑ Castellanos, Agustin (1997). “Electrocardiography in Clinical Practice: Adult and Pediatric, Fourth Edition. By T. Chou. W.B. Saunders, Philadelphia (1996) 729 pages, illustrated, $99.00 ISBN: 0721656471”. Clinical Cardiology. 20 (5): 505–505. doi:10.1002/clc.4960200521. ISSN 0160-9289.
↑ Spodick DH (1976). “Differential characteristics of the electrocardiogram in early repolarization and acute pericarditis”. N Engl J Med. 295 (10): 523–6. doi:10.1056/NEJM197609022951002. PMID 950958.
↑ Ginzton LE, Laks MM (1982). “The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria”. Circulation. 65 (5): 1004–9. doi:10.1161/01.cir.65.5.1004. PMID 7074735.
↑ Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA (2003). “The early repolarization normal variant electrocardiogram: correlates and consequences”. Am J Med. 115 (3): 171–7. doi:10.1016/s0002-9343(03)00355-3. PMID 12935822.
↑ http://en.ecgpedia.org

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[Castellanos1997-1] Castellanos, Agustin (1997). “Electrocardiography in Clinical Practice: Adult and Pediatric, Fourth Edition. By T. Chou. W.B. Saunders, Philadelphia (1996) 729 pages, illustrated, $99.00 ISBN: 0721656471”. Clinical Cardiology. 20 (5): 505–505. doi:10.1002/clc.4960200521. ISSN 0160-9289.

[pmid950958-2] Spodick DH (1976). “Differential characteristics of the electrocardiogram in early repolarization and acute pericarditis”. N Engl J Med. 295 (10): 523–6. doi:10.1056/NEJM197609022951002. PMID 950958.

[pmid7074735-3] Ginzton LE, Laks MM (1982). “The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria”. Circulation. 65 (5): 1004–9. doi:10.1161/01.cir.65.5.1004. PMID 7074735.

[pmid12935822-4] Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA (2003). “The early repolarization normal variant electrocardiogram: correlates and consequences”. Am J Med. 115 (3): 171–7. doi:10.1016/s0002-9343(03)00355-3. PMID 12935822.

[5] ttp://en.ecgpedia.org

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HIV induced pericarditis electrocardiogram

Overview

Electrocardiogram

References

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