Cardiovascular Medicine Book

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EKG in PericarditisAka: Electrocardiogram in Pericarditis

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  1. Indication
    1. Suspected Pericarditis
  2. Epidemiology
    1. Sensitivity
      1. Abnormal changes in 90% of Pericarditis cases
      2. All 4 EKG stages seen in <50% of Pericarditis cases
  3. Findings: General
    1. ST segment
      1. Concave upward ("Smiley face")
        1. Similar to early repolarization
        2. Contrast with Myocardial Infarction
          1. ST is convex upward in EKG in Acute MI
      2. ST segment changes often diffuse
        1. Contrast with focal changes on EKG in Acute MI
      3. ST segment to T Wave ratio (measure in lead V6)
        1. Pericarditis: >0.25
        2. Early Repolarization: <0.25
      4. Absent Reciprocal ST segment changes
    2. PR Segment
      1. PR Segment depression present
        1. Very specific for Pericarditis
      2. PR Segment depression absent
        1. Myocardial Infarction
        2. Early repolarization
    3. Other findings on EKG associated with Pericarditis
      1. Low Voltage
      2. Electrical alternans
  4. Findings: Stage 1 Pericarditis Changes
    1. Timing
      1. Onset: Day 2-3
      2. Duration: Up to 2 weeks
    2. Findings
      1. Diffuse concave upward ST segment elevation
      2. ST segment depression in leads aVR or V1
      3. Concordant T Wave changes
      4. PR Segment depression in leads II, AVF, and V4-V6
  5. Findings: Stage 2 Pericarditis Changes
    1. Timing
      1. Duration: Days to several weeks
    2. Findings
      1. ST segment returns to baseline
      2. T Wave flattens
  6. Findings: Stage 3 Pericarditis Changes
    1. Timing
      1. Onset: Week 2-3
      2. Duration: Several weeks
    2. Findings
      1. ST segment returns to baseline
      2. T Wave inverts in leads II, AVF, and V4-V6
  7. Findings: Stage 4 Pericarditis Changes
    1. Timing
      1. Duration: Up to 3 months
    2. Findings
      1. Gradual resolution of T Wave inversion

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