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Stemi vs pericarditis ECG diagnosis
1. ACUTE STEMI vs PERICARDITIS
ECG DILEMMA
Dr. Syed Haseeb Raza
FCPS Cardiology, Clinical Cardiac Electrophysiologist
Author of ECG Book and Researcher
National Institute of Cardiovascular Diseases, Karachi, Pakistan.
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5. Classical Teachings about Pericarditis
• Diffuse ST elevation in all leads
• ST elevation is concave upwards
• PR segment depression with PR elevation in lead aVR
6. ..
• Classic Teaching
• Diffuse ST elevation in all leads
In reality : may be localized instead of diffuse
Pearl : No ST segment depression except in leads aVR and V1
• ST elevation is concave upwards
Acute STEMI can also give such configuration.
Pearl : ST segment elevation that is convex upwards and horizontal
strongly favors STEMI
Another pearl : STE II > STE III favors Pericarditis
STE III > STE II favors STEMI
• PR segment depression with PR elevation in lead aVR
In reality : PR segment depression is an early transient finding
It also occurs in ACS ( when there is atrial injury )
So ,,,its NOT pathognomic for Pericarditis
20. The most marked finding in this ECG is PR depression in multiple leads
BUT question is
What is the reference for ST elevation or depression in the presence of PR
depression ???
“Its T-P segment”
So taking T-P segment as standard what is happening in lead III and V6 ??
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26. Take Home Message
Step 1 : ST segment depression beyond aVR and V1
if YES its STEMI if NOT , move to next step 2
Step 2 : ST segment elevation convex upwards or horizontal
if YES its STEMI if NOT, move to next step 3
Step 3 : STE III > STE II if YES its STEMI
if NOT, move to next step 4
Step 4 : Pronounced PR depression in multiple leads
if YES its PERICARDITIS