APIK Journal of Internal Medicine

: 2020  |  Volume : 8  |  Issue : 3  |  Page : 145--146

ECG diagnosis

Raghavendra Bhat 
 Department of Internal Medicine, Ras AL Khaimah Medical and Health Sciences University, Ras Al Kahimah, UAE

Correspondence Address:
Dr. Raghavendra Bhat
Department of Internal Medicine, Ras AL Khaimah Medical and Health Sciences University, Ras Al Kahimah

How to cite this article:
Bhat R. ECG diagnosis.APIK J Int Med 2020;8:145-146

How to cite this URL:
Bhat R. ECG diagnosis. APIK J Int Med [serial online] 2020 [cited 2020 Sep 30 ];8:145-146
Available from: http://www.ajim.in/text.asp?2020/8/3/145/289801

Full Text


 View AnswerAcute pericarditis generalizes elevation of the ST segment with concavity inwardPR segment depression is best seen in I, II, III, AVL, and aVFDiagnosis: Acute pericarditis.

 Quiz 1

What is the main finding?

Diffuse ST-segment elevation.

 Quiz 2

What are the features of diffuse ST-segment elevation in this electrocardiogram (ECG)?

Diffuse ST-segment elevation with concavity inwardReciprocal ST-segment depression in aVR not in aVLST-segment elevation <5 mmPR-segment depression – A unique feature.

 Quiz 3

What are the other causes of diffuse ST-segment elevation and what are the distinguishing features [Figure 1]?{Figure 1}

Normal – Male pattern – Seen in 90% of healthy young men, 1–3 mm elevation, concave, most marked in V2Early repolarization – Best in V4, notching at J point, tall upright T waves, reciprocal ST depression in aVR and not in aVLLeft ventricular hypertrophy (LVH) – Concave, other features of LVHLeft bundle branch block – Concave, ST-segment deviation discordant from QRSHyperkalemia – Wide QRS, tall peaked tented T waves; low amplitude or absent P waves, ST-segment downslopingBrugada Syn – rSR' in V1 and V2; ST-segment elevation in V1 and V2 – typically downslopingPulmonary embolism – Simulates acute myocardial infarction (AMI) – in both inferior and anteroseptal leadsCardioversion-Striking ST elevation >10mm–transient -lasting 1 or 2 min immediately after direct current shockPrinzmetal's angina – Same as ST-segment elevation in AMI but transientAMI – ST-segment with plateau or shoulder or upsloping; reciprocal behavior between aVL and III.

 Quiz 4

What are the ECG features of acute pericarditis?

Diffuse ST-segment elevation with concavity + no reciprocal depressionPR-segment depression – CommonQ waves none – Unless accompanied by infarctionT waves inverted after the J point returns to the baselineArrhythmia – NoneConduction abnormalities – None.

 Quiz 5

What are the stages of acute pericarditis?

Stage I: Elevation of ST-segment concave upward – generalized except in aVR and V1 (where it may show a depression). T waves are upright in leads where there is ST-segment elevationStage II: ST segment returns to baseline and the T waves flattenStage III: Inversion of T wavesStage IV: Reversion of T waves to normal.

 Quiz 6

What are the arrhythmias seen in acute pericarditis?

20% may have arrhythmias. Proximity to the sinoatrial node and perinodal tissue may be responsible. Sinus tachycardia, sinus bradycardia, intermittent atrial fibrillation, paroxysmal supraventricular tachycardia, A. Flutter can occur. V. Tac and V. Fibrillation is unknown in uncomplicated pericarditis.

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Conflicts of interest

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