New electrocardiographic criteria to differentiate acute pericarditis and myocardial infarction

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2014Author
Rosselló, Xavier
Wiegerinck, Rob F.
Alguersuari, Joan
Bardají, Alfredo
Worner, Fernando
Sutil, Mario
Ferrero, Andreu
Cinca, Juan
Suggested citation
Rosselló, Xavier;
Wiegerinck, Rob F.;
Alguersuari, Joan;
Bardají, Alfredo;
Worner, Fernando;
Sutil, Mario;
...
Cinca, Juan.
(2014)
.
New electrocardiographic criteria to differentiate acute pericarditis and myocardial infarction.
The American Journal of Medicine, 2014, vol. 127, núm. 3, p. 233-239.
https://doi.org/10.1016/j.amjmed.2013.11.006.
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Show full item recordAbstract
Objective
Transmural myocardial ischemia induces changes in QRS complex and QT interval duration but, theoretically, these changes might not occur in acute pericarditis provided that the injury is not transmural. This study aims to assess whether QRS and QT duration permit distinguishing acute pericarditis and acute transmural myocardial ischemia.
Methods
Clinical records and 12-lead electrocardiogram (ECG) at ×2 magnification were analyzed in 79 patients with acute pericarditis and in 71 with acute ST-segment elevation myocardial infarction (STEMI).
Results
ECG leads with maximal ST-segment elevation showed longer QRS complex and shorter QT interval than leads with isoelectric ST segment in patients with STEMI (QRS: 85.9 ± 13.6 ms vs 81.3 ± 10.4 ms, P = .01; QT: 364.4 ± 38.6 vs 370.9 ± 37.0 ms, P = .04), but not in patients with pericarditis (QRS: 81.5 ± 12.5 ms vs 81.0 ± 7.9 ms, P = .69; QT: 347.9 ± 32.4 vs 347.3 ± 35.1 ms, P = .83). QT interval dispersion among the 12-ECG leads was greater in STEMI than in patients with pericarditis (69.8 ± 20.8 ms vs 50.6 ± 20.2 ms, P <.001). The diagnostic yield of classical ECG criteria (PR deviation and J point level in lead aVR and the number of leads with ST-segment elevation, ST-segment depression, and PR-segment depression) increased significantly (P = .012) when the QRS and QT changes were added to the diagnostic algorithm.
Conclusions
Patients with acute STEMI, but not those with acute pericarditis, show prolongation of QRS complex and shortening of QT interval in ECG leads with ST-segment elevation. These new findings may improve the differential diagnostic yield of the classical ECG criteria.
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The American Journal of Medicine, 2014, vol. 127, núm. 3, p. 233-239European research projects
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