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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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HIV induced pericarditis electrocardiogram

Introduction

Overview

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

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:
    • 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

References

  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.
  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.
  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.
  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. ↑ http://en.ecgpedia.org

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