Published February 2021
Eric Rudofker, MD
Expert review – pending
Identify the key ECG findings (diffuse ST elevation and PR depression with PR elevation in aVR) for diagnosis of pericarditis.
Plan to spend 5-15 minutes familiarizing yourself with the ECG and relevant background information. Have the image pulled up on the presenting screen or monitor. Have one learner provide a systematic interpretation of the ECG. If they do not do so on their own, prompt them to point out and characterize the specific abnormalities in the ST and PR segments. Then ask them to commit to a specific diagnosis. Advance through the animations to highlight the abnormalities and final diagnosis.
Official ECG Read: Normal sinus rhythm, normal axis. Concave ST elevations in I, II, III, aVF, V3-V6. PR depressions in I, II, III, aVF, V3-V6, with reciprocal PR elevation in aVR.
Clinical Diagnosis: Pericarditis
Teaching: Concave ST elevations are associated with more benign causes of ST elevations. Diffuse ST elevation and PR depression with reciprocal PR changes in aVR is suggestive of pericarditis. Consider pericarditis when symptom onset is associated with URI symptoms
Take Home Point
- Diffuse ST elevation and PR depression with reciprocal PR changes in aVR is suggestive of pericarditis.
- Consider pericarditis when chest pain is positional and onset is associated with URI symptoms
- Concave ST elevations are associated with more benign causes of ST elevations.
Goldberger, A. L., Shvilkin, A., Goldberger, Z. D. (2017). Clinical Electrocardiography: A Simplified Approach E-Book. United States: Elsevier Health Sciences.
Lewinter MM, Imazio M. Chapter 83: Pericardiac Diseases. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease. 11th ed. Elsevier. 2019:1664.