The pattern of diffuse ST elevations with PR depressions on ECG is most consistent with which condition?

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Diffuse ST elevations with PR segment depressions point to acute pericarditis. Inflammation of the pericardial sac causes a current of injury that broadens the ST segments across many leads, and the atrial current of injury lowers the PR segment, producing PR depression in most leads (often with PR elevation in aVR). This pattern is typically diffuse and often concave upward, unlike the localized, territory-specific ST elevations seen in a myocardial infarction. In a STEMI you’d expect focal ST elevations corresponding to a coronary artery territory, sometimes with reciprocal changes in opposite leads. Hyperkalemia presents with tall peaked T waves and wide QRS complexes, not diffuse ST elevations with PR depression. Atrial flutter shows sawtooth flutter waves, not this ST/PR pattern. So the described ECG finding most strongly supports acute pericarditis.