IIIaVRV4

1 = ST elevation in stage 1.   2 = ST T change in stage 2.   3 = ST T change in stage 3.   4 = PR shift.   4' = PR shift in aVR.   ST' = Reciprocal ST depression in aVR (only)

Pericarditis, acute (Case 2)

Patient. 19 yo female Down syndrome with history of flu like illness for one week. She had chest pain on admission. There was no pericardial friction rub. Echocardiogram showed small pericardial effusion. Troponin was 5.7.

ST T abnormality in Pericarditis. Stage:  1. ST elevation in most leads except in aVR and less in V1, The T wave is upright. The ST segment remains in concave characteristic. ST is depressed in aVR (reciprocal change). (case 1)  2. ST elevation returns towards baseline, while T wave amplitude decreases and T wave begins to invert. The ST segment may have convex characteristic.  3. ST elevation returns to baseline. T wave is inverted.  4. ECG pericarditic abnormality returns to baseline. Comment: Duration for each stage varies. There may be changes in different stages in different leads in the same ECG. Stage 1 through 3 duration is usually less than 1 week. Stage 4 may last days to weeks. What separate pericarditis diagnosis from other causes of ST elevation is the widespread ST elevation and no reciprocal ST depression (except in aVR). This ECG represents stage 1 through 3 pericarditis ST T change in different leads. Other abnormality:   PR segment shift. PR depression may be seen in most leads except V1, while there is PR elevation in aVR (reciprocal change). Go to Case 1

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