STEMI vs. acute pericarditis

ECG findings in STEMI vs. Acute Pericarditis

Know the differences & use a stepwise approach looking for STEMI first!

Step 1. Do you see any of the following findings that strongly suggest STEMI?

• Reciprocal ST depression in any leads (except aVR & V1)

  • • OR for STEMI = 31

• STE in lead III > the STE in lead II ​​​​​​​​

  • • OR for STEMI = 21

• Horizontal or convex upward ST-segment morphology

  • • OR for STEMI =6

• R-T sign or “checkmark sign”

  • • OR for STEMI = 8

• Q-waves that you know are new​​ (be cautious it they are old)

Look for the factors that rule in STEMI before thinking pericarditis!

Step 2. After looking for STEMI, you can look for features that suggest pericarditis:

• Pronounced PR-segment depression in multiple leads (only reliably seen in viral acute pericarditis, may be transient)

• Pericardial friction rub

• Spodick sign (may be suggestive of pericarditis if no signs of STEMI found)

When in doubt…do serial ECGs and consider CATH!