HIV induced pericarditis electrocardiogram

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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.
• IF pericarditis does not follow myocarditis and vice versa, the differentiation is made as following:
  • 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:
    • Pericarditis is not followed by ST-segment elevation and T wave.
    • Those changes are pretty common in STEMI.
  • 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