ECG in *carditis and

BERThe faces of ECG series

Objectives

• Mechanism of changes in pericarditis

• ECG in pericarditis

• Pericardial effusion

• Mechanism of changes in BER

• ECG in BER

A Touch of Anatomy

Case ExampleA 49yo male. Found collapsed at homeby a friend. Has been unwell for the lastfortnight - has been short of breath, chest pain.

Case ExampleA 49yo male. Found collapsed at home by a friend. Has been unwell for the last fortnight - has been short of breath, chest pain.

Case ExampleA 49yo male. Found collapsed at home by a friend. Has been unwell for the last fortnight - has been short of breath, chest pain. A double trouble.

Pericardial Abnormalities

Acute pericarditis

Pericardial Abnormalities

Acute pericarditis

ST/T ratio in V6 >0.25 - pericarditis

ST T

V6

Pericardial Abnormalities

ECG stages of acute pericarditisSTAGE CHANGES ON ECG

I Diffuse concave STE with concordance of TW;

STD in aVR or V1;

PR-segment depression; low voltage;

Absence of reciprocal ST segment changes

II ST segments return to baseline;

TW flattening

 

III TW inversion

IV Gradual resolution

aVR

Pericardial Abnormalities

ECG stages of acute pericarditisSTAGE CHANGES ON ECG

I Diffuse concave STE with concordance of TW;

STD in aVR or V1;

PR-segment depression; low voltage;

Absence of reciprocal ST segment changes

II ST segments return to baseline;

TW flattening

 

III TW inversion

IV Gradual resolution

aVR

Pericardial Abnormalities

ECG stages of acute pericarditisSTAGE CHANGES ON ECG

I Diffuse concave STE with concordance of TW;

STD in aVR or V1;

PR-segment depression; low voltage;

Absence of reciprocal ST segment changes

II ST segments return to baseline;

TW flattening

 

III TW inversion

IV Gradual resolution

aVR

Pericardial Abnormalities

ECG stages of acute pericarditisSTAGE CHANGES ON ECG

I Diffuse concave STE with concordance of TW;

STD in aVR or V1;

PR-segment depression; low voltage;

Absence of reciprocal ST segment changes

II ST segments return to baseline;

TW flattening

 

III TW inversion

IV Gradual resolution

aVR

Pericardial Abnormalities

- Classic four stage presentation is rare- ST elevation is small- Dynamic ST changes are usually absent- Normal SR or tachycardia are most common

Case Example35yo male brought in ED afteran altercation at a communitygathering with a stab wound to upper abdomen. He is pale, thrashing on the gurney. HR 108bpm, sBP107mmHg. ChestUS showed no pneumothorax.

Case Example35yo male brought in ED after an altercation at a community gathering with a stab wound to upper abdomen….

Case Example49yo woman with metastatic breast cancer. She is pale with cool periph-eries, sBP 95mmHg, HR 109bpm.

Case Example49yo woman with metastatic breast cancer. She is pale with cool peripheries, sBP 95mmHg, HR 109bpm.

Pericardial Abnormalities

Pericardial Effusion- Low QRS and T wave voltage

- Electrical alternans- QRS complex- QRS-T- P-QRS-T

- PEA- Sinus tachycardia

Pericardial Abnormalities

Pericardial effusion- ECG is often normal. NO ECG finding is diagnostic.- Reduction in ECG voltage compared to previous

ECG is very suggestive.- P-QRS-T alternans is highly suggestive of cardiac

tamponade.

Case ExampleYoung man with chest painafter weight lifting.

Case ExampleYoung woman found collapsed near a night club.

Benign Early Repolarization

Features- ST segment elevation- Concave ST segment- Concordant, large TW- Widespread STE- Temporal stability

Case ExampleYoung woman found collapsed near a night club.

Isoelectric PR

Case ExampleYoung man with chest painafter weight lifting.

Isoelectric PR

BER v Pericarditis v AMI

?

BER v Pericarditis v AMI

Notched J point

Concave ST

BER v Pericarditis v AMI

Notched J pointST elevation

PR depression

Concave ST

BER v Pericarditis v AMI

Notched J pointST elevation

Convex ST

PR depression

Concave ST

The End