ECG: Pericarditis

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ECG: Pericarditis

  1. 1. ECG OF THE WEEK PROF.DR.K.H NOORUL AMEEN UNIT DR.M.JAGADEESAN I YR PG
  2. 2. <ul><li>A 58 year old male came with c/o breathlessness,chest pain.k/c DM, SHT ,CKD </li></ul><ul><li>o/e pedal edema </li></ul>
  3. 3. Ecg taken
  4. 4. findings <ul><li>NSR </li></ul><ul><li>HR 100/min </li></ul><ul><li>P wave morphology-N </li></ul><ul><li>QRS axis </li></ul><ul><li>QRS-N </li></ul><ul><li>ST segment –concave upwards in L1,LII,avL,avF,V4-V6 ;depressed in avR&V1. </li></ul>
  5. 5. PERICARDITIS <ul><ul><li>Pericarditis is a disorder caused by inflammation of the pericardium , the serous membrane enclosing the heart and the roots of the great blood vessels. </li></ul></ul><ul><ul><li>Fibrinous, aseptic inflammation (predominantly lymphocytic) is the hallmark of uremic pericarditis. </li></ul></ul>
  6. 6. Evolution of pericarditis <ul><li>Acute phase </li></ul><ul><li>Subacute or evolving phase </li></ul><ul><li>Chronic phase </li></ul>
  7. 7. Basic electrocardiographic effects <ul><li>Acute epicardial injury is reflected by ST segment deviation towards the injured surface. </li></ul><ul><li>Epicardial ischemia is reflected by T wave deviation away from the ischemic region </li></ul><ul><li>Electrical short circuiting effect results in dimished magnitude/electric alternans </li></ul>
  8. 8. Acute pericarditis <ul><li>  ECG changes include diffuse concave upward ST elevation, except in leads aVR and V1 (usually depressed). T waves are upright in the leads with ST elevation. </li></ul><ul><li>Upright T waves may be the earliest sign </li></ul><ul><li>Sinus tachycardia is almost invariably associated. </li></ul><ul><li>The reciprocal ST segment changes or pathological Q wqves of MI not seen </li></ul><ul><li>The most sensitive ECG change characteristic of acute pericarditis is ST-segment elevation, which reflects the abnormal repolarization that develops secondary to pericardial inflammation.2 Depression of the PR segment is very specific of acute pericarditis and is attributed to subepicardial atrial injury and occurs in all leads except aVR and V1. These leads may exhibit PR-segment elevation . </li></ul>
  9. 10. Subacute or evolving phase <ul><li>ST segment changes tending to become convex upward and then isoelectric </li></ul><ul><li>T wave also loses amplitude and becomes isoelectric </li></ul>
  10. 11. chronic <ul><li>It is characterised by </li></ul><ul><li>Low to inverted T waves in most leads </li></ul><ul><li>Diminished amplitude of all the ecg detections </li></ul><ul><li>Potential elctrical alternans best seen in midprecordial leads </li></ul>
  11. 13. Chronic
  12. 15. DD –ST elevation <ul><li>MI </li></ul><ul><li>ACUTE PERICARDITIS </li></ul><ul><li>LVH </li></ul><ul><li>VENTRICULAR ANEURYSM </li></ul><ul><li>ERS </li></ul><ul><li>HYPOTHERMIA </li></ul>
  13. 16. <ul><li>Single electrocardiographic complexes comparing (left) acute pericarditis, (center) early repolarization and (right) injury pattern of acute myocardial infarction. The degree of ST-segment elevation is greater in the pericarditis complex than in the early repolarization complex. Important findings of acute infarction include the presence of Q waves and a more convex upward ST segment, both of which are present in the right complex. </li></ul>
  14. 17. ECG finding Acute pericarditis Myocardial infarction Early repolarization ST-segment shape Concave upward Convex upward Concave upward Q waves Absent Present Absent Reciprocal ST-segment changes Absent Present Absent Location of ST-segment elevation Limb and precordial leads Area of involved artery Precordial leads ST/T ratio in lead V6* >0.25 N/A <0.25 Loss of R-wave voltage Absent Present Absent PR-segment depression Present Absent Absent  
  15. 19. CAUSES <ul><li>ACUTE RHEUMATIC FEVER </li></ul><ul><li>VIRAL </li></ul><ul><li>UREMIA RELATED </li></ul><ul><li>Late start of, or inadequate hemodialysis  Retained uremic toxins  Loss of residual renal function </li></ul><ul><li>DRESSLER </li></ul><ul><li>TB </li></ul><ul><li>MYXOEDEMA </li></ul><ul><li>MALIGNANCY </li></ul><ul><li>Side effect  of some  medications , e.g.  isoniazid ,  cyclosporine ,  hydralazine ,  warfarin , and  heparin </li></ul>
  16. 21. Acute

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