HIV induced pericarditis electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]


Acute pericarditis can mimic myocardial infarction (STEMI) signs and electrocardiogram and present with chest pain and cardiac enzyme (bio-marker) elevation the differentiation is made by specific features.


  • Acute pericarditis can mimic myocardial infarction (STEMI) signs and electrocardiogram and present with chest pain and cardiac enzyme (bio-marker) elevation.[1]
  • IF pericarditis does not follow myocarditis and vice versa, the differentiation is made as following:[2][3][4]
    • Morphology:
      • Start of ST-elevation: in acute pericarditis begins at the J point(termination of depolarization junction)
      • STEMI patients present a dome-shaped ST-elevation that can be more than 5MM in height.
    • Distribution:
      • Pericarditis shows a non-specific ST-elevation pattern while STEMI shows specific changes based on the infarction location.
    • Reciprocal changes:
      • STEMI is often associated with reciprocal changes.
      • Pericarditis reciprocal changes are just seen in leads aVR and V1.
    • Concurrent ST and T wave changes:
    • PR segment:
      • Pericarditis shows PR elevation in aVR with PR depression in other leads because of atrial injury.
      • STEMI does not show such changes.
    • Other signs:
      • Hyperacute T waves
      • New pathologic Q waves
      • QT prolongation
      • These signs are rarely seen in acute pericarditis
  • Shown below is an EKG with the presence of micro-voltage and electrical alternans suggesting pericardial effusion and cardiac tamponade.

Copyleft image obtained courtesy of ECGpedia [5]


  1. Castellanos, Agustin (1997). "Electrocardiography in Clinical Practice: Adult and Pediatric, Fourth Edition. By T. Chou. W.B. Saunders, Philadelphia (1996) 729 pages, illustrated, $99.00 ISBN: 0721656471". Clinical Cardiology. 20 (5): 505–505. doi:10.1002/clc.4960200521. ISSN 0160-9289.
  2. Spodick DH (1976). "Differential characteristics of the electrocardiogram in early repolarization and acute pericarditis". N Engl J Med. 295 (10): 523–6. doi:10.1056/NEJM197609022951002. PMID 950958.
  3. Ginzton LE, Laks MM (1982). "The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria". Circulation. 65 (5): 1004–9. doi:10.1161/01.cir.65.5.1004. PMID 7074735.
  4. Klatsky AL, Oehm R, Cooper RA, Udaltsova N, Armstrong MA (2003). "The early repolarization normal variant electrocardiogram: correlates and consequences". Am J Med. 115 (3): 171–7. doi:10.1016/s0002-9343(03)00355-3. PMID 12935822.

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