How can pericarditis be differentiated from STEMI on ECG?

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Multiple Choice

How can pericarditis be differentiated from STEMI on ECG?

Distinguishing pericarditis from STEMI on ECG comes down to how the ST changes are distributed and whether PR segments change. Pericarditis typically shows diffuse, widespread ST elevations across many leads with a concave-upward shape, and it is accompanied by PR-segment depression (often with PR elevation in aVR). Crucially, there are no reciprocal ST-segment depressions in opposite leads. STEMI, by contrast, produces ST elevations that are localized to the affected arterial territory and is usually accompanied by reciprocal ST depressions in leads opposite that area, with the elevations often having a more convex appearance. This combination—diffuse elevations with PR depression and no reciprocal changes—best points to pericarditis, while localized elevations with reciprocal changes indicate STEMI.

Distinguishing pericarditis from STEMI on ECG comes down to how the ST changes are distributed and whether PR segments change. Pericarditis typically shows diffuse, widespread ST elevations across many leads with a concave-upward shape, and it is accompanied by PR-segment depression (often with PR elevation in aVR). Crucially, there are no reciprocal ST-segment depressions in opposite leads. STEMI, by contrast, produces ST elevations that are localized to the affected arterial territory and is usually accompanied by reciprocal ST depressions in leads opposite that area, with the elevations often having a more convex appearance. This combination—diffuse elevations with PR depression and no reciprocal changes—best points to pericarditis, while localized elevations with reciprocal changes indicate STEMI.

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