HIV induced pericarditis electrocardiogram: Difference between revisions

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__NOTOC__
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{{HIV induced pericarditis}}
{{HIV induced pericarditis}}
{{Pericarditis}}


{{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
{{CMG}} {{AE}} {{RG}}
==Overview==
Acute [[pericarditis]] can mimic myocardial infarction (STEMI) signs and electrocardiogram and present with chest pain and cardiac enzyme (bio-marker) elevation the differentiation is made by specific features.  


====Electrocardiogram====
==Electrocardiogram==
The presence of micro-voltage and [[electrical alternans]] suggests [[pericardial effusion]] and [[cardiac tamponade]].
*Acute [[pericarditis]] can mimic myocardial infarction (STEMI) signs and electrocardiogram and present with chest pain and cardiac enzyme (bio-marker) elevation.<ref name="Castellanos1997">{{cite journal|last1=Castellanos|first1=Agustin|title=Electrocardiography in Clinical Practice: Adult and Pediatric, Fourth Edition. By T. Chou. W.B. Saunders, Philadelphia (1996) 729 pages, illustrated, $99.00 ISBN: 0721656471|journal=Clinical Cardiology|volume=20|issue=5|year=1997|pages=505–505|issn=01609289|doi=10.1002/clc.4960200521}}</ref>
[[Image:PulsusAlternans.jpg|thumb|500px|center|Micro-voltage with electrical alternans]]
*IF pericarditis does not follow [[myocarditis]] and vice versa, the differentiation is made as following:<ref name="pmid950958">{{cite journal| author=Spodick DH| title=Differential characteristics of the electrocardiogram in early repolarization and acute pericarditis. | journal=N Engl J Med | year= 1976 | volume= 295 | issue= 10 | pages= 523-6 | pmid=950958 | doi=10.1056/NEJM197609022951002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=950958  }} </ref><ref name="pmid7074735">{{cite journal| author=Ginzton LE, Laks MM| title=The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria. | journal=Circulation | year= 1982 | volume= 65 | issue= 5 | pages= 1004-9 | pmid=7074735 | doi=10.1161/01.cir.65.5.1004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7074735  }} </ref><ref name="pmid12935822">{{cite journal| author=Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA| title=The early repolarization normal variant electrocardiogram: correlates and consequences. | journal=Am J Med | year= 2003 | volume= 115 | issue= 3 | pages= 171-7 | pmid=12935822 | doi=10.1016/s0002-9343(03)00355-3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12935822  }}</ref>
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**Morphology:
***Start of ST-elevation: in acute pericarditis begins at the [[J point wave|J point]](termination of depolarization junction)
***[[ST elevation myocardial infarction|STEMI]] patients present a dome-shaped ST-elevation that can be '''more''' than '''5MM''' in height.
**Distribution:
***Pericarditis shows a non-specific ST-elevation pattern while [[ST elevation myocardial infarction|STEMI]] shows specific changes based on the infarction location.
**Reciprocal changes:
***[[STEMI]] is often associated with reciprocal changes.
***Pericarditis reciprocal changes are just seen in leads [[aVR]] and V1.
**Concurrent [[ST]] and [[T wave|T]] wave changes:
***Pericarditis is not followed by [[ST-segment elevation]] and [[T wave|T]] wave.
***Those changes are pretty common in [[ST elevation myocardial infarction|STEMI]].
**[[PR segment]]:
***Pericarditis shows [[PR segment|PR]] elevation in [[aVR]] with [[PR segment|PR]] [[PR depression|depression]] in other leads because of [[atrial]] injury.
***STEMI does not show such changes.
**Other signs:
***Hyperacute T waves
***New pathologic Q waves
***QT prolongation
***These signs are rarely seen in acute pericarditis
*Shown below is an EKG with the presence of micro-voltage and [[electrical alternans]] suggesting [[pericardial effusion]] and [[cardiac tamponade]].
 
[[Image:PulsusAlternans.jpg|center|500px]]
'''Copyleft image obtained courtesy of ECGpedia''' <ref>http://en.ecgpedia.org</ref>


==References==
==References==
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[[Category:Emergency medicine]]
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Latest revision as of 02:43, 18 December 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

Overview

Acute pericarditis can mimic myocardial infarction (STEMI) signs and electrocardiogram and present with chest pain and cardiac enzyme (bio-marker) elevation the differentiation is made by specific features.

Electrocardiogram

  • Acute pericarditis can mimic myocardial infarction (STEMI) signs and electrocardiogram and present with chest pain and cardiac enzyme (bio-marker) elevation.[1]
  • IF pericarditis does not follow myocarditis and vice versa, the differentiation is made as following:[2][3][4]
    • Morphology:
      • Start of ST-elevation: in acute pericarditis begins at the J point(termination of depolarization junction)
      • STEMI patients present a dome-shaped ST-elevation that can be more than 5MM in height.
    • Distribution:
      • Pericarditis shows a non-specific ST-elevation pattern while STEMI shows specific changes based on the infarction location.
    • Reciprocal changes:
      • STEMI is often associated with reciprocal changes.
      • Pericarditis reciprocal changes are just seen in leads aVR and V1.
    • Concurrent ST and T wave changes:
    • PR segment:
      • Pericarditis shows PR elevation in aVR with PR depression in other leads because of atrial injury.
      • STEMI does not show such changes.
    • Other signs:
      • Hyperacute T waves
      • New pathologic Q waves
      • QT prolongation
      • These signs are rarely seen in acute pericarditis
  • Shown below is an EKG with the presence of micro-voltage and electrical alternans suggesting pericardial effusion and cardiac tamponade.

Copyleft image obtained courtesy of ECGpedia [5]

References

  1. ↑ Castellanos, Agustin (1997). "Electrocardiography in Clinical Practice: Adult and Pediatric, Fourth Edition. By T. Chou. W.B. Saunders, Philadelphia (1996) 729 pages, illustrated, $99.00 ISBN: 0721656471". Clinical Cardiology. 20 (5): 505–505. doi:10.1002/clc.4960200521. ISSN 0160-9289.
  2. ↑ Spodick DH (1976). "Differential characteristics of the electrocardiogram in early repolarization and acute pericarditis". N Engl J Med. 295 (10): 523–6. doi:10.1056/NEJM197609022951002. PMID 950958.
  3. ↑ Ginzton LE, Laks MM (1982). "The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria". Circulation. 65 (5): 1004–9. doi:10.1161/01.cir.65.5.1004. PMID 7074735.
  4. ↑ Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA (2003). "The early repolarization normal variant electrocardiogram: correlates and consequences". Am J Med. 115 (3): 171–7. doi:10.1016/s0002-9343(03)00355-3. PMID 12935822.
  5. ↑ http://en.ecgpedia.org

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