What are the electrocardiogram (EKG) findings in pericarditis?

From the Guidelines

Pericarditis on EKG is best diagnosed and managed by identifying stage I anterior and inferior concave ST segment elevation, PR segment deviations opposite to P polarity, and subsequent stages of ST and T wave changes, as outlined in the European Society of Cardiology guidelines 1. The diagnostic approach to pericarditis involves several key steps, including:

• ECG analysis to identify characteristic ST segment elevation and PR segment depression, with specific lead involvement and evolution through stages I to IV 1
• Auscultation for pericardial rub, which can be mono-, bi-, or triphasic 1
• Echocardiography to assess for pericardial effusion and signs of tamponade, with effusion types B-D (Horowitz) being indicative of pericarditis 1
• Blood analyses for markers of inflammation, such as ESR, CRP, and LDH, as well as troponin I and CK-MB for myocardial lesion assessment 1 Treatment of pericarditis primarily involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs), with ibuprofen being the preferred choice due to its favorable impact on coronary flow and rare side effects, at a dose of 300-800 mg every 6-8 hours, continued for days or weeks until the effusion has disappeared 1. Additional treatment considerations include:
• Colchicine (0.5 mg bid) as an adjunct to NSAIDs or as monotherapy for initial attack and recurrence prevention, with a level of evidence B and class IIa indication 1
• Systemic corticosteroid therapy restricted to specific etiologies, such as connective tissue diseases, autoreactive or uremic pericarditis 1
• Hospitalization for determination of etiology, observation for tamponade, and treatment effect, with mandatory pericardiocentesis and drainage in cases of tamponade (indication class I) 1

From the Research

Pericarditis on EKG

• Pericarditis is the inflammation of the pericardium, the membranous sac surrounding the heart 2
• The treatment of pericarditis typically involves empiric anti-inflammatory therapy, with aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) being the mainstay of therapy 3
• Colchicine is often used as an adjunct to NSAIDs, particularly for recurrent pericarditis, and has been shown to be effective in reducing the number of pericarditis recurrences 2, 4
• The choice of NSAID should be dictated by comorbid conditions, tolerability, and adverse effects, with aspirin being the drug of choice in patients with coronary artery disease (CAD), heart failure (HF), or renal disease 5

Diagnosis and Treatment

• The diagnosis of pericarditis is typically made based on clinical presentation, electrocardiogram (EKG) findings, and echocardiography 2
• The treatment of pericarditis should be individualized, with the goal of providing full daily control of symptoms and preventing recurrences 3
• Colchicine monotherapy has been shown to be effective in preventing recurrent pericarditis, although more studies are needed to fully elucidate its efficacy 6

Pharmacologic Treatment

• Available treatments for acute and recurrent pericarditis include aspirin or NSAIDs, colchicine, glucocorticoids, immunosuppressive agents, immunoglobulins, and anti-interleukin-1 (IL-1) agents 4
• Colchicine is the mainstay of treatment in acute and recurrent pericarditis, while anti-IL1 agents are a valuable option in case of recurrent pericarditis refractory to conventional drugs 4