1 From the Cardiology Division, Lemuel Shattuck Hospital, and Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
Diagnostic electrocardiographic patterns were analyzed in 50 consecutive patients who had unequivocal clinical evidence of acute pericarditis. Distributions of P and QRS, and of P-R segment, ST-segment and T wave changes were plotted by lead and by mean frontal vector (Â). Transient gross deviations of P-R segments, mainly in Stages 1 and/or 2, occurred in 41 patients (82%) and could produce an optical illusion of ST elevations when the J-points were actually on the baseline.  P-R was close to 180° opposite to  P and was not related to P wave or heart rate changes. In Stage 1,  ST tended to be concordant with  QRS and  T. T wave inversions in Stage 3 produced an  T which was distributed over an arc of 210° with no range of predilection. Transient increase in magnitude of a normally oriented PR vector was consistent with the subepicardial atrial injury of acute pericarditis. It is the analogue of the classic Stage 1 ST-segment abnormalities of subepicardial ventricular injury and was equally as widespread in the electorcardiogram and almost as prevalent. P-R segment deviations were always depressions for leads of "epicardial" patterns. ST-segment deviations departed from the classic elevation pattern in 10 patients: 7 patients in whom ST was depressed in Lead III, 5 of whom had a horizontal QRS axis; and 3 patients in whom ST was depressed in aVL, two of whom had a vertical QRS axis. In Stage 3, the much wider range for  T as compared with the relatively concentrated early injury vectors,  P-R and  ST, is ascribed to greater inhomogeneity of post-injury ventricular repolarization.
Submitted on March 26, 1973
© 1973 American Heart Association, Inc.
Diagnostic Electrocardiographic Sequences in Acute Pericarditis
Significance of PR Segment and PR Vector Changes
Key Words: ST segment • ST vector • T vector
Accepted on April 26, 1973
This article has been cited by other articles:
 |
|
 |
|
  G. D. Lewis, C. B. Holmes, G. Holmvang, and J. R. Butterton Case 8-2007 -- A 48-Year-Old Man with Chest Pain Followed by Cardiac Arrest N. Engl. J. Med., March 15, 2007; 356(11): 1153 - 1162. [Full Text] [PDF]
|
|
|
|
|
|
R. A. Lange and L. D. Hillis Acute Pericarditis N. Engl. J. Med., November 18, 2004; 351(21): 2195 - 2202. [Full Text] [PDF]
|
|
|
|
 |
|
 D. H. Spodick Low Voltage With Pericardial Effusion: Complexity of Mechanisms Chest, December 1, 2003; 124(6): 2044 - 2045. [Full Text] [PDF]
|
|
|
|
|
|
Y. Kudo, F. Yamasaki, T. Doi, Y. Doi, and T. Sugiura Clinical Significance of Low Voltage in Asymptomatic Patients With Pericardial Effusion Free of Heart Disease Chest, December 1, 2003; 124(6): 2064 - 2067. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.-J. Hung, L.-T. Kuo, and W.-J. Cherng Acute Pericarditis Following Percutaneous Transluminal Coronary Intervention: A Case Report Angiology, July 1, 2003; 54(4): 503 - 506. [Abstract] [PDF]
|
|
|
|
 |
|
 D. H. Spodick Acute Pericarditis: Current Concepts and Practice JAMA, March 5, 2003; 289(9): 1150 - 1153. [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Kudo, F. Yamasaki, Y. Doi, and T. Sugiura clinical correlates of pr-segment depression in asymptomatic patients with pericardial effusion J. Am. Coll. Cardiol., June 19, 2002; 39(12): 2000 - 2004. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Nagahama, T. Sugiura, K. Takehana, N. Tarumi, T. Iwasaka, and M. Inada PQ Segment Depression in Acute Q Wave Inferior Wall Myocardial Infarction Circulation, February 1, 1995; 91(3): 641 - 644. [Abstract] [Full Text]
|
|
|
|
 |
|
 J. D. Thomas and M. M. LeWinter Pericardial Disease in the Intensive Care Setting J Intensive Care Med, January 1, 1987; 2(1): 33 - 48. [Abstract] [PDF]
|
|