PR Segment Elevation
PR Segment Elevation
PR Segment Elevation
“PASTOR” is used to remember the key features of acute pericarditis and aid in diagnosis and management. It stands for Pleuritic chest pain, Auscultatory pericardial friction rub, ST-segment elevation on ECG (and/or PR depression), Temperature elevation (fever), Other associated symptoms (like dyspnea, cough, etc.), and Recent viral illness or other underlying causes.
Here’s a breakdown of the mnemonic:
- Pleuritic chest pain: Pain that worsens with breathing and lying down, and is relieved by sitting up and leaning forward.
- Auscultatory pericardial friction rub: A characteristic scratching, squeaking, or crunching sound heard with a stethoscope, indicating inflammation of the pericardium.
- ST-segment elevation on ECG (and/or PR depression): The electrocardiogram may show widespread ST-segment elevation (and PR depression), which is a common finding in acute pericarditis.
- Temperature elevation (fever): Fever is a common systemic sign of inflammation.
- Other associated symptoms: Pericarditis can be accompanied by other symptoms like dyspnea, cough, fatigue, and myalgias.
- Recent viral illness or other underlying causes: Many cases of pericarditis are triggered by viral infections, but other causes include bacterial infections, autoimmune diseases, and trauma.
PR Segment Elevation
V5 -PR-segment-depression PR segment depression in V5 due to acute pericarditis concave ST elevation also present suggesting – acute pericarditis
Key Points on PR Segment Elevation
| No. | Detail | Explanation |
|---|---|---|
| 1 | Normal PR segment | Typically isoelectric (flat), lies between the P wave and QRS |
| 2 | Lead aVR | PR segment elevation in aVR is normal if <0.5 mm |
| 3 | Pericarditis | Shows PR elevation in aVR and PR depression in multiple other leads |
| 4 | Atrial infarction | Rare but can cause PR elevation due to atrial injury |
| 5 | Early repolarization or normal variant | Occasionally seen, especially in young, healthy individuals |
| 6 | TP segment as baseline | Used as the reference point instead of PR segment to identify PR elevation |
| 7 | Acute pericarditis hallmark | Widespread ST elevation + PR depression (except PR elevation in aVR) |
| 8 | ECG progression in pericarditis | Stage 1 includes PR elevation in aVR |
| 9 | Differentiation from MI | PR segment elevation with ST depression in aVR suggests pericarditis, not MI |
| 10 | PR segment vs ST segment | Both reflect different parts of electrical activity; PR is atrial, ST is ventricular |
| 11 | No reciprocal changes | In pericarditis, no reciprocal ST depressions, unlike STEMI |
| 12 | Lead V1 PR elevation | Can be seen in pericarditis or atrial infarction |
| 13 | Associated symptoms | Chest pain relieved by sitting forward (pericarditis), helps in diagnosis |
| 14 | ST segment in pericarditis | Concave ST elevations, unlike the convex “tombstone” pattern of MI |
| 15 | Autoimmune causes | Pericarditis from lupus or rheumatoid arthritis may show PR elevation |
| 16 | Infectious pericarditis | Coxsackievirus, tuberculosis may show PR changes |
| 17 | Trauma-related | PR segment elevation post-cardiac surgery or trauma indicates pericardial inflammation |
| 18 | No Q waves | Pericarditis lacks Q waves typical of infarction |
| 19 | PR segment depression | Seen in inferior and lateral leads in pericarditis |
| 20 | Treatment implication | NSAIDs are mainstay in pericarditis, not thrombolysis like in MI |
Mnemonic to Remember PR Segment Elevation in Pericarditis:
“PR aVR = Pericarditis Review”
P = PR elevation
R = Reciprocal PR depression
aVR = Only lead with PR elevation
Review = Think pericarditis when you see it
What is PR Segment Elevation?
- Definition: Elevation of the PR segment above the baseline (TP segment) on the ECG.
- Location: Most notably seen in lead aVR, and sometimes in V1.
- Clinical importance: Depending on the context and associated findings, it can be a sign of acute pericarditis or atrial infarction.
| Mnemonic to Remember PR Segment Elevation in Pericarditis: “PR aVR = Pericarditis Review” P = PR elevation R = Reciprocal PR depression aVR = Only lead with PR elevation Review = Think pericarditis when you see it |
ECG findings suggestive of acute pericarditis
EKG findings suggestive of acute pericarditis acute pericarditis Myocardial Infarctiom 1 ST-elevation is less than 5 mm 2 ST-segment concavity ST-segment elevation usually “concave” upward 3 More extensive lead involvement Diffuse ST elevation ST-elevation related to location of ischemia 4 Less prominent reciprocal ST-segment depression 5 PR-segment elevation in aVR, with reciprocal PR-segment depression in other leads PR-segment depression often occurs No PR-segment depression 6 The absence of abnormal Q-waves 7 Variability in the time of T-wave inversion occurrence following ST-segment elevation 8 The lack of QRS widening and QT interval shortening in leads with ST-elevation Spodick’s sign...
