Acute pericarditis: clinical features

• atypical chest pain

• friction rub

• widespread ST elevations on EKG

Atypical chest pain

• this type of chest pain is worse when you take a deep breath, which is almost never the case when you have ischemic pain

• sometimes difficult to distinguish from MI

• might decrease in intensity upon sitting up

• characteristically, pain may radiate to the trapezius ridge

Pericardial friction rub

• present in up to 85% of cases

• squeaky sound: two layers of pericardium rubbing together

• three phases: early diastole, late diastole, systole

• best heard with diaphragm of stethoscope over left sternal border

EKG changes: know this for the exam

• these are different from the MI EKG changes

• EKG goes through four stages

  • 1 diffuse ST elevation, concave up

  • 2 normalization of ST

  • 3 inversion of T waves

  • 4 normalization

EKG example

• stage 1:all the leads except aVR show diffuse, concave up ST elevation; there are no T wave inversions 5-2

  • if it were acute MI, it wouldn’t be diffuse. it would have ST elevation on a few leads

  • PR depression is sometimes seen

• after the STs come down, you see T wave inversion
  

• then, they go back to normal
  

Category: Pathology Notes