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12 Lead in ECG acute pericarditis
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ACUTE PERICARDITIS
ECG
Pericardium to pericarditis
INCIDENCE
• 90% of patients with acute pericarditis have ECG changes
Four stages< 50% of patients
• I• II• III• IV
Stage I
• Sinus tachycardia is common • ST-segment elevation in all leads except aVR and V1• Normal T-wave axis• PR-segment depression• ST segment is usually concave upward• No regional lead distributions
12 Lead ECG in stage I
All the leads except
Except V1 and aVR
Stage II
• ST segment returns to baseline and flattening of T waves occurs, typically during several days
Stage III
• T-wave inversion occurs in stage III when ST segment is normal• Sometimes with ST-segment depression
Stage IV
• ST segments and T waves return to normal• Complete normalization may require weeks to months
Variation
• Classical changes may not go through each of these phases in an individual case• PR-segment depression has been reported in about 80% of patients• PR-segment depression is one of the earliest electrocardiographic• Manifestations of pericarditis, occurring in the first few hours of
presentation and often preceding ST-segment elevation• Ventricular tachycardia and conduction abnormalities are suggestive
of myocardial involvement with ischemia(Myopericarditis)
Differential diagnosis
• Early repolarisation• Acute STEMI
Normal variant of early repolarisation
The ST-segment elevation of pericarditis can be differentiatedfrom the normal variant of early repolarization if the ratio of ST to T wave in V6 is greater than 25%
Acute STEMI
• ST elevation goes hand in hand with T wave inversion
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