ECG in *carditis and BER

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

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

Case Example
A 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
V6 ST T

Pericardial Abnormalities
ECG stages of acute pericarditis
STAGE CHANGES ON ECG

Diffuse concave STE with concordance of TW; STD in aVR or V1; PR-segment depression; low voltage; Absence of reciprocal ST segment changes ST segments return to baseline; TW flattening

aVR

II

III

TW inversion

IV

Gradual resolution

Pericardial Abnormalities
ECG stages of acute pericarditis
STAGE CHANGES ON ECG

Diffuse concave STE with concordance of TW; STD in aVR or V1; PR-segment depression; low voltage; Absence of reciprocal ST segment changes ST segments return to baseline; TW flattening

aVR

II

III

TW inversion

IV

Gradual resolution

Pericardial Abnormalities
ECG stages of acute pericarditis
STAGE CHANGES ON ECG

Diffuse concave STE with concordance of TW; STD in aVR or V1; PR-segment depression; low voltage; Absence of reciprocal ST segment changes ST segments return to baseline; TW flattening

aVR

II

III

TW inversion

IV

Gradual resolution

Pericardial Abnormalities
ECG stages of acute pericarditis
STAGE CHANGES ON ECG

Diffuse concave STE with concordance of TW; STD in aVR or V1; PR-segment depression; low voltage; Absence of reciprocal ST segment changes ST segments return to baseline; TW flattening

aVR

II

III

TW inversion

IV

Gradual resolution

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 Example
35yo male brought in ED after an altercation at a community gathering with a stab wound to upper abdomen. He is pale, thrashing on the gurney. HR 108bpm, sBP107mmHg. Chest US showed no pneumothorax.

Case Example
35yo male brought in ED after an altercation at a community gathering with a stab wound to upper abdomen.

Case Example
49yo woman with metastatic breast cancer. She is pale with cool peripheries, sBP 95mmHg, HR 109bpm.

Case Example
49yo 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 Example
Young man with chest pain after weight lifting.

Case Example
Young 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 Example
Young woman found collapsed near a night club.

Isoelectric PR

Case Example
Young man with chest pain after weight lifting.

Isoelectric PR

BER v Pericarditis v AMI

BER v Pericarditis v AMI

Concave ST

Notched J point

BER v Pericarditis v AMI

Concave ST PR depression

Notched J point

ST elevation

BER v Pericarditis v AMI

Concave ST PR depression

Convex ST
Notched J point ST elevation

The End