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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Understanding Pericarditis and its ECG Manifestations
Introduction
Pericarditis is an inflammation of the pericardium, the sac surrounding the heart. It can cause chest pain and characteristic changes on an electrocardiogram (ECG). Understanding these ECG changes is crucial for early diagnosis and management.
Causes of Pericarditis
Pericarditis can be caused by: - Viral or bacterial infections - Autoimmune disorders (e.g., lupus, rheumatoid arthritis) - Post-myocardial infarction inflammation (Dressler’s syndrome) - Uremia (kidney failure-related pericarditis) - Malignancies - Radiation therapy
ECG Findings in Pericarditis
Pericarditis typically progresses through four stages on ECG: 1. Stage 1 (Acute Phase): - Diffuse ST-segment elevation (concave upward, seen in multiple leads except aVR and V1) - PR-segment depression (most evident in lead II, V5, and V6) 2. Stage 2 (Early Resolution): - ST-segment normalizes - T waves may flatten 3. Stage 3 (T-Wave Inversion): - T waves become inverted, usually in leads with prior ST elevation 4. Stage 4 (ECG Normalization): - ECG returns to normal
Differential Diagnosis
It is crucial to differentiate pericarditis from myocardial infarction (MI), as both may have ST elevation: - Pericarditis: Diffuse, concave ST elevation, PR depression, no reciprocal ST depression - MI: Localized ST changes, reciprocal ST depression, pathological Q waves possible
Treatment Approaches
- Medications: NSAIDs (e.g., ibuprofen), colchicine for recurrent cases, corticosteroids in resistant cases
- Lifestyle Modifications: Rest, avoiding strenuous activity
- Hospitalization: Indicated for complicated cases (e.g., pericardial effusion, tamponade)
Conclusion
Recognizing ECG changes in pericarditis is critical for timely diagnosis and management. Proper differentiation from MI helps prevent unnecessary interventions.
Source recommendations
1. American Heart Association Guidelines on Pericardial Diseases
- https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.561514
- https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis
- https://www.sciencedirect.com/science/article/abs/pii/S1936878X24001608
- https://www.jacc.org/doi/10.1016/j.jacc.2019.11.021
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
2. European Society of Cardiology Guidelines on Pericardial Diseases
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
- https://academic.oup.com/eurheartj/article/36/42/2921/2293375
- https://pubmed.ncbi.nlm.nih.gov/26320112/
- https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/10/30/12/01/2015-esc-guidelines-for-the-diagnosis-and-management-of-pericardial-diseases
- https://pubmed.ncbi.nlm.nih.gov/15120056/
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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