From the Guidelines
In acute pericarditis, lead aVR typically shows ST segment depression, which is a characteristic finding that helps distinguish pericarditis from other conditions like myocardial infarction. This finding is part of the characteristic ECG pattern seen in pericarditis, which includes diffuse ST segment elevation in most leads with PR segment depression, as noted in the guidelines on the diagnosis and management of pericardial diseases 1. Lead aVR demonstrates the opposite pattern compared to other leads, showing ST depression rather than elevation, because it faces the heart from the right shoulder perspective, providing a view that is electrically opposite to most other leads. The temporal evolution of ECG changes with acute pericarditis is highly variable from one patient to another and is affected by therapy, as reported in the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1.
Some key points to consider in the diagnosis of acute pericarditis include:
- The ECG changes, including ST segment elevation in most leads and ST segment depression in lead aVR, are highly suggestive of pericarditis 1
- The inflammatory process affects the entire pericardial surface surrounding the heart, creating a pattern of current flowing away from the aVR lead, resulting in ST depression 1
- The diagnosis of acute pericarditis should be considered in the context of other clinical findings, including chest pain, fever, and elevated markers of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) 1
- The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine are recommended for the treatment of acute pericarditis, with the goal of reducing inflammation and preventing recurrence 1.
Overall, the finding of ST segment depression in lead aVR, in combination with other characteristic ECG changes and clinical findings, is highly suggestive of acute pericarditis, and should be considered in the diagnosis and management of patients with suspected pericarditis 1.
From the Research
Electrocardiographic Changes in Acute Pericarditis
- In acute pericarditis, several electrocardiographic (ECG) changes can occur, including changes in lead aVR 2.
- Lead aVR is often overlooked but can provide valuable information in certain clinical scenarios, such as acute pericarditis 2.
- Specifically, in acute pericarditis, PR-segment elevation can be observed in lead aVR, which can be a useful diagnostic clue 2.
Clinical Context and Treatment
- Acute pericarditis is typically treated with anti-inflammatory medications, such as aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and colchicine 3, 4, 5, 6.
- Colchicine has been shown to be effective in reducing the risk of recurrent pericarditis and is often used as an adjunct to NSAIDs or aspirin 4, 5, 6.
- The treatment of acute pericarditis should be individualized, and the choice of medication and dosage should be tailored to the specific patient's needs 3.