Acute Pericarditis ECG
The ECG in patients with acute pericarditis goes through 4 stages. The classic findings are widespread ST-segment elevation and PR depression. These changes are present during the acute phase, which has an onset within hours and may last a few days. The ST and PR segments usually normalize during the transitional second stage. The third stage is marked by diffuse T wave inversions, while the fourth is represented by either normalization of the the ECG or permanence of the t wave inversion. This temporal evolution of ECG changes is highly variable, and with disease progression, other nonspecific abnormalities may develop as well.
Widespread elevation of the ST-segment above the isoelectric line is the most common finding of acute pericarditis. Unlike with myocardial infarction, the ST segment elevation is typically concave upward. While ST-segment elevation can occur in most leads, it is usually normal or depressed in leads AVR and V1. Depression of the PR segment below the isoelectric line is a more specific finding for acute pericarditis than ST elevation. It is also widespread, except in leads AVR and V1 in which it can be elevated.
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