What ECG finding is characteristic of acute pericarditis, ST elevation (convex upward) or ST elevation (concave upward)?

From the Guidelines

ST elevation with a concave upward appearance is characteristic of acute pericarditis. This differs from the convex or dome-shaped ST elevation typically seen in acute myocardial infarction. In pericarditis, the ST segment elevation is usually widespread, appearing in most leads except aVR and V1, where ST depression may be present. This diffuse pattern reflects the inflammation of the pericardium affecting the entire heart surface rather than a localized area. Additionally, PR segment depression may be present, which is another distinguishing feature of pericarditis. The concave upward ST elevation occurs because the inflammatory process affects the epicardial surface first, causing current to flow toward the affected area during ventricular repolarization. These ECG changes typically evolve over time, with ST elevation resolving and T wave inversions developing in later stages of the disease. Recognizing this pattern is crucial for differentiating pericarditis from acute coronary syndromes, which require very different management approaches. According to the guidelines on the diagnosis and management of pericardial diseases, ECG is recommended in all patients with suspected acute pericarditis 1.

Key features of the ECG in acute pericarditis include:

• Widespread ST segment elevation, typically concave upward
• ST depression in leads aVR and V1
• PR segment depression
• Evolution of ECG changes over time, with resolution of ST elevation and development of T wave inversions. The most recent and highest quality study, the 2015 ESC guidelines for the diagnosis and management of pericardial diseases, supports the use of ECG in diagnosing acute pericarditis 1.

In terms of ECG findings, the study by the European Society of Cardiology found that ST elevation with a concave upward appearance is a characteristic finding in acute pericarditis 1. This is in contrast to the convex or dome-shaped ST elevation typically seen in acute myocardial infarction. The ECG changes in pericarditis are usually widespread, appearing in most leads except aVR and V1, where ST depression may be present.

Overall, the characteristic ECG finding in acute pericarditis is ST elevation with a concave upward appearance, which is supported by the most recent and highest quality studies 1.

From the Research

ECG Findings in Acute Pericarditis

The characteristic ECG finding in acute pericarditis is:

• ST elevation, which is typically concave upward 2, 3

Differentiation from Other Conditions

It's essential to differentiate acute pericarditis from other conditions that may present with ST elevation, such as:

• Acute myocardial infarction, which often presents with ST elevation that is convex upward 4, 5

Key ECG Features

The key ECG feature that distinguishes acute pericarditis from other conditions is the morphology of the ST segment elevation:

• Concave upward ST elevation is more characteristic of acute pericarditis 2, 3
• Convex upward ST elevation is more characteristic of acute myocardial infarction 4, 5