From the Guidelines
The EKG findings of paracarditis, also known as pericarditis, typically include widespread ST segment elevation across multiple leads, PR segment depression, and absence of reciprocal ST depression, as described in the 2015 ESC guidelines 1. The ST elevation is usually concave upward (saddle-shaped) and appears in most leads except aVR and V1, where ST depression may occur.
- PR segment depression, particularly in lead II, is a specific finding for pericarditis.
- As the condition progresses, T wave flattening followed by T wave inversion may develop, but this occurs after ST segments have normalized.
- Electrical alternans, characterized by beat-to-beat variation in QRS amplitude, suggests pericardial effusion.
- Low voltage QRS complexes may be present if significant effusion exists.
- Sinus tachycardia is common due to inflammation and fever. These EKG changes follow a typical four-stage progression:
- Stage I (acute) with ST elevation and PR depression,
- Stage II with normalization of ST segments and T wave flattening,
- Stage III with T wave inversions, and
- Stage IV with normalization of the EKG or persistence of T wave changes, as outlined in the European Society of Cardiology guidelines 1. The most recent and highest quality study, the 2015 ESC guidelines 1, provides the best evidence for the diagnosis and management of pericardial diseases, and should be used to guide clinical decision-making. The temporal evolution of ECG changes with acute pericarditis is highly variable from one patient to another and is affected by therapy, as noted in the 2015 ESC guidelines 1. Major differential diagnoses include acute coronary syndromes with ST-segment elevation and early repolarization, and elevation of markers of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), as well as elevation of the white blood cell count, may be helpful for monitoring the activity of the disease and efficacy of therapy 1.
From the Research
EKG Findings of Paracarditis
- The EKG findings of paracarditis, also known as acute pericarditis, include diffuse concave-upward ST-segment elevation and PR-segment depression 2.
- The ST-segment elevation in acute pericarditis is typically concave and diffuse, whereas in ST-elevated myocardial infarction (STEMI), it is usually convex and localized 3.
- The ratio of ST-segment elevation to T wave >0.24 in lead V6 is also a characteristic feature of acute pericarditis 3.
- PR segment depression is another common EKG finding in acute pericarditis, which can be seen in leads DII, DIII, aVF, and V3-6 4.
- QRS complex and QT interval changes can also help differentiate acute pericarditis from STEMI, with STEMI showing longer QRS complex and shorter QT interval in leads with ST-segment elevation 5.
- QT interval dispersion among the 12-ECG leads is greater in STEMI than in patients with pericarditis, which can aid in the differential diagnosis 5.