Elias Hanna, MD, Cardiology

PR depression Diffuse ST-segment elevation in ~all leads with ST depression in aVR initially suggests pericarditis. Furthermore, PR depression in leads II, aVF, V5, V6 further suggests pericarditis. However, having pericarditis features does not necessarily imply pericarditis. In order to say this is not STEMI, you should search for the 4 STEMI features and make sure none of them is present (as per next slide). On this ECG, the morphology of the ST segment and the T wave morphology do not support pericarditis. ST-elevation is an upwardly convex ST elevation with a wide and high T wave fused with ST (leads V2-V4).This is very typical of STEMI. Also, the size of the ST elevation, > 5 mm in V2-V4, and larger than QRS in V4, is not consistent with pericarditis. ST elevation that is larger than QRS is very worrisome for STEMI.

-Diffuse ST-segment elevation in ~all leads with ST-segment depression in aVR initially suggests pericarditis. Furthermore, PR depression in leads II, aVF, V5, V6 further suggests pericarditis. -However, having pericarditis features does not necessarily imply pericarditis. In order to rule out STEMI, you should search for the 4 STEMI features and make sure none of them is present (as per next slide). -On this ECG, the morphology of the ST segment and the T wave morphology are 2 features that do not support pericarditis. ST-elevation is upwardly convex with a wide and high T wave that is fused with ST segment (see leads V2-V4).This shape is very typical of STEMI. *Also, the size of the ST elevation, > 5 mm in V2-V4 and larger than QRS in V4, is not consistent with pericarditis. ST elevation that is larger than QRS is very worrisome for STEMI.

-This pt had mid-LAD occlusion -This pt had mid-LAD occlusion. Anterior STEMI may be associated with diffuse ST-segment elevation, particularly when a wrap-around LAD is occluded in its mid-segment leading to inferior ST-segment elevation rather than reciprocal inferior ST-segment depression *PR depression may be seen with MI and implies atrial infarction of post-MI pericarditis