The 4 Stages Of A Pericarditis ECG: What To Expect….

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pericarditis ECGTo diagnose the symptoms of pericarditis, an ECG can be helpful. Inflammation of the pericardium can produce a characteristic type of chest pain. It is located behind the sternum and is pleuritic in nature. Pericarditis pain worsens on lying down flat and is relieved by sitting up. This may be associated with a fast heart rate and shortness of breath. If you are suffering from one or some of the pericarditis symptoms, then your physician might run an Pericarditis ECG to confirm the condition.

Pericarditis ECG Changes

The ECG changes produced in pericarditis occur as the underlying pericardium becomes involved. The most common ECG finding is a widespread ST segment elevation. Here are a few common findings that are observed in an ECG of a patient with pericarditis:

  • Widespread concave ST segment elevation throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6). This is usually modest around 0.5 to 1mm.
  • There is widespread PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6).
  • There will be a reciprocal ST depression and PR elevation in lead aVR.
  • The pain and acute inflammation of pericarditis may also produce sinus tachycardia.

Stages Of Pericarditis In A Pericarditis ECG

Classically Pericarditis ECG findings are thought to evolve though four main stages. However,  less than 50% people follow through these classic four stages generally, often evolution of change may not follow this specific pattern. The four stages on an ECG are:

  •  Stage 1: This stage spans over the first two weeks. There is a general ST elevation in all leads with the exception of aVR, V1 and III. PR depression is also generally seen throughout the same leads too. Reciprocal changes are seen in lead aVR.
  • Stage 2: This stage spans over the next 1 to 3 weeks. In this stage, there is a normalization of ST changes. There is also a generalized T wave flattening in all the leads. This stage is also called the psuedonormalization stage as the ECG gets normal in this transition period before more changes are observed.
  • Stage 3: This stage starts after three weeks for the next several weeks. It is characterised by T wave inversion of the flattened T waves.
  • Stage 4: After the next several weeks, the ECG goes back to normalization and this marks the fourth stage of pericarditis.

What Is The Difference Between Pericarditis ECG And Myocardial Infarction ECG?

Generalised concave up ST elevation and PR elevation in aVR can cause confusion between pericarditis and myocardial infarction (NSTEMI). Both of these conditions do not have a significantly different history either. They can both present with a pleuritic type chest pain and a pericardial friction rub. Here are a few signs which might confuse the diagnosis of pericarditis with STEMI:

  • Pericarditis can cause ST elevation in a localized area but doesn’t produce any reciprocal ST depression in other areas except aVR and V1.
  • STEMI also causes concave up ST segment like pericarditis.
  • But, only STEMI can cause convex up or horizontal ST elevation.
  • An ST elevation that is stronger in II and III suggests an STEMI.
  • The PR segment depression is caused in viral pericarditis only. In most of the cases, it is an early transient phenomenon that lasts only for hours. A STEMI can also cause PR segment depression due to atrial infarction. It can also appear as PR segment elevation in aVR.
  • There are a few signs on the ECG that can help differentiate pericarditis from STEMI. These include:
    -If the ST elevation is not localized and it is present on a lead other than aVR or aVF, it is a STEMI.
    – If there is a convex up or horizontal ST elevation, it suggests STEMI.
    – If the ST elevation is greater in lead II or III, it is suggestive of a STEMI.
    – If there is PR depression in multiple leads, it will clearly suggest that this is a pericarditis ECG.

Benefits of A Pericarditis ECG

    An ECG provides valuable information to your treating physician to ensuring they understand what stage your Pericarditis is and what future treatment will be needed. Here is some additional information on what a

Pericarditis ECG looks like.




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