ECG changes in acute pericarditis
ECG changes in acute pericarditis
Typical EKG changes in acute pericarditis includes
- stage 1 — diffuse, positive, ST elevations with reciprocal ST depression in aVR and V1. Elevation of PR segment in aVR and depression of PR in other leads especially left heart V5, V6 leads indicates atrial injury.
- stage 2 — normalization of ST and PR deviations
- stage 3 — diffuse T wave inversions (may not be present in all patients)
- stage 4 — EKG becomes normal OR T waves may be indefinitely inverted
ECG changes in Acute Pericarditis (stepwise progression):
🔹 ECG Stages of Acute Pericarditis
Stage I (hours to days)
- Diffuse ST-segment elevation (concave upwards, “saddle-shaped”) in most leads except aVR & V1
- PR-segment depression (most specific sign), best seen in limb leads & precordial leads
- Reciprocal PR elevation & ST depression in aVR and sometimes V1
Stage II (days to weeks)
- ST segments return to baseline
- T-wave flattening begins
Stage III (after 2–3 weeks)
- T-wave inversion in most leads (after ST normalization)
Stage IV (weeks to months)
- ECG returns to normal (T waves may remain inverted in some cases)
🔑 Key ECG Features of Acute Pericarditis
- Widespread, concave ST elevation (not limited to one coronary territory)
- PR depression (most specific sign)
- Absence of reciprocal ST depression (except in aVR, V1)
- No pathological Q waves
- Dynamic evolution through 4 stages
| Feature | Acute Pericarditis | Myocardial Infarction |
|---|---|---|
| ST Elevation | Diffuse, concave | Regional, convex |
| Reciprocal ST depression | Only aVR, V1 | Present in opposite leads |
| PR depression | Common | Rare |
| Q waves | Absent | Present |
| Evolution | 4 stages | Persistent Q waves, localized T inversion |
1. The most specific ECG finding of acute pericarditis is:
PR-segment depression is the most specific sign of pericarditis.
2. ST elevation in acute pericarditis is usually:
In pericarditis, ST elevation is typically widespread and concave (“saddle-shaped”).
3. Reciprocal ST depression is classically seen in acute pericarditis in:
In pericarditis, reciprocal ST depression occurs mainly in aVR and sometimes V1.
4. Which ECG change typically appears first in acute pericarditis?
Stage I: PR depression + diffuse concave ST elevation appear first.
5. In which stage of acute pericarditis does T-wave inversion appear?
Stage III: after ST normalization, T-wave inversion develops.
6. Which ECG feature helps differentiate acute pericarditis from myocardial infarction?
PR depression is rare in MI but common in acute pericarditis.
7. Q waves are typically:
Q waves are absent in pericarditis, unlike myocardial infarction.
8. Stage II of pericarditis is characterized by:
Stage II: normalization of ST segments with T wave flattening.
9. T-wave inversion in pericarditis occurs:
T inversion follows ST normalization (Stage III).
10. Stage IV of acute pericarditis usually shows:
Stage IV is resolution, ECG may normalize or T inversion may persist.
11. Widespread concave ST elevation in acute pericarditis typically spares:
ST elevation is diffuse but usually spares aVR and V1.
12. Which of the following is NOT seen in acute pericarditis?
Pathological Q waves are absent in pericarditis.
13. PR elevation is seen in pericarditis in:
PR elevation is reciprocal, best seen in aVR.
14. Sinus tachycardia in pericarditis is:
Sinus tachycardia may occur due to pain or inflammation but is nonspecific.
15. Which finding favors pericarditis over STEMI?
Diffuse concave ST elevation without Q waves suggests pericarditis.
16. In pericarditis, ST/T ratio in lead V6 is usually:
ST/T ratio >0.25 in V6 favors pericarditis over early repolarization.
17. Evolution of ECG in pericarditis typically occurs over:
ECG evolves over days to weeks through 4 stages.
18. Which leads best show PR depression?
PR depression is best seen in limb and lateral precordial leads.
19. A hallmark of stage I pericarditis is:
Stage I: diffuse ST elevation + PR depression = classic combination.
20. Which of the following best summarizes ECG changes in acute pericarditis?
The 4 stages: ST/PR changes → normalization → T inversion → recovery.
