How do we diagnose pericarditis?
A December 2014 NEJM article(1) provides a good clinical practice review of this topic.
To diagnose pericarditis we need a minimum of 2 of the following 4 criteria:
1 Typical chest pain
-Especially pleuritic pain, preacordial or retrosternal, relieved by sitting forward
-Pain that radiates to trapezius ridge(2) (considered pathognomonic)
2 Pericardial Friction Rub- this is transient
3 Typical ECG changes
-ST elevation across several territories
- No reciprocal ST depression, except in aVR + V1
4 Pericardial effusion
-Usually described as > 20mm in width
If we analyse this ECG using the ECG in 20 seconds approach:
Rate: 84 bpm
P waves: Upright in I, II and inverted in aVR = leads in right place and normal sinus rhythm
QRS: Not too tall, not too small, normal morphology
ST-T segments Saddle shaped elevation in II,avF, V4-6 – this widespread ST elevation with no reciprocal changes ie., no reciprocal ST depression, indicates pericarditis.