Which electrocardiogram (ECG) findings are helpful in narrowing the differential diagnosis of acute pericarditis?

Updated: Apr 02, 2019
  • Author: Sean Spangler, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Some ECG findings that may be helpful include the following:

  • Repolarization does not progress through stages and is uncommonly associated with PR depression; serial monitoring of ECGs in young patients with chest pain helps differentiate early repolarization from acute pericarditis

  • An ST-segment–to–T-wave ratio of 0.25 or more in V6 can distinguish acute pericarditis from early repolarization

  • The ST segment in acute MI is usually convex, bowing upward with reciprocal changes, as opposed to concave ST segments without reciprocal changes observed in acute pericarditis and repolarization

  • A study by Rossello et al indicated that unlike patients with acute ST-segment elevation MI (STEMI), patients with acute pericarditis do not show prolongation of the QRS complex and shortening of the QT interval in ECG leads with ST-segment elevation [31]

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