Acute Pericarditis: Diagnosis

by Carlo Raj, MD

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    00:01 Physical examination: leathery pericardial friction rub can be heard. “Leathery”.

    00:11 ST elevation, now, stage one: hours to days. Okay. And then couple other things that will point at to you.

    00:20 First and foremost, if it’s within, stage one hours to days. Verse to keep myocardial infarction in terms of what? Transmural, you’ll find what kind of change in EKG? It was called ST-elevation.

    00:32 But if I told you two three AVF, you would then be thinking. Thinking what? Right coronary artery.

    00:36 What if you’ll find ST elevation, every single lead. Huh, wow. That’s a myocardial infarction every single lead.

    00:42 Are you kidding me? No, no, no, no.

    00:44 This is not Kawasaki. And even Kawasaki wouldn’t be such diffuse ST elevation. Right? So all leads, you might find ST elevation. But what else is important? Pay attention.

    00:56 PR depression. Close your eyes. Tell me about that PR interval. Isoelectric or wavy? Isoelectric. How important is PR interval? How about ridiculous import? What do you mean? Well, PR interval is between 0.1 to 0.2 seconds, that you must be firmly, firmly edge in your head.

    01:16 0.1 to 0.2 seconds. Why is that important Dr. Raj? Because you’ve heard of AV block.

    01:21 So when we do arrhythmias, when we do first degree, second degree Mobitz type 1, Mobitz type 2.

    01:27 We’ll talk about that PR interval, won’t we? And with AV blocks, what happens to PR interval? It’s prolonged. It’s isoelectric. Okay? So separate topic at a separate time.

    01:38 However, clinically significant, isoelectric. There is a PR elevation. Where? You take PR and associate this with the augmented lead aVR. Clear? You’d find this more so with acute pericarditis.

    01:54 There are no Q waves. And by that, we don’t mean that there’s no negative deflexion.

    01:58 You do not find the exaggerated negative deflexion that you might find with chronic MI.

    02:03 That must be understood. And every once a while, later on, in stages that you get with acute pericarditis which is a bit too much information. But, nonetheless, let me just point it out that there might be diffuse T wave inversions. Later on in stage three in such.

    02:18 But for right now, let’s just stick with the basics. Stage one, ST elevation, all leads.

    02:24 PR interval, aVR, R and R. Let that help you.

    02:30 Echo. Effusion. So half of your patients, you might actually find effusion taking place in your pericardial cavity.

    02:39 Now, if you take a look at this EKG, you will take a look at most these leads.

    02:43 And we looking at ST elevation. ST elevation, ST elevation.

    02:47 Sees them really good ones right there at the bottom.

    02:49 Like one you do. So you find ST elevations in every single lead. Would they give you all 12 leads? Of course they would. But, you have to make sure, you know is to what you’re looking for.

    03:00 And base in the history of your patient and then you take a look at the EKG. You cannot go wrong.

    03:04 So, if your patient is telling you, leaning back at hurts, stabbing chest pain. You take a look with the EKG and you’ll find all of these ST elevations, acute pericarditis.

    03:17 Acute pericarditis is here as well. Every single ST elevation. Every single lead. ST elevation.

    About the Lecture

    The lecture Acute Pericarditis: Diagnosis by Carlo Raj, MD is from the course Pericardial Disease.

    Included Quiz Questions

    1. There are Q waves.
    2. Global ST-elevation
    3. PR depression in most leads
    4. PR elevation in aVR lead
    5. All of the above
    1. All of the above
    2. Leathery friction rub on auscultation
    3. Muffled heart sounds
    4. Pain is relieved by leaning forward
    5. Low grade fever

    Author of lecture Acute Pericarditis: Diagnosis

     Carlo Raj, MD

    Carlo Raj, MD

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