Diagnostic Dilemma of Pericarditis Concurrent With ST Elevation Myocardial Infarction

Alsagaff, Mochamad Yusuf; Oktaviono, Yudi Her; Lusida, Terrence Timothy Evan

doi:10.1001/jamainternmed.2022.0318

“…On the ECG, we noticed Spodick sign, which was not described by Dr Alsagaff and colleagues in the case report. The ECG features of acute pericarditis usually include 4 stages.…”

supporting

confidence: 46%

“…In this patient case, Spodick sign seems to be masked in the ECG at presentation owing to the fast heart rate and long PR interval. In the patient’s follow-up ECG (after rescue percutaneous coronary intervention), the inferior leads evolved after acute myocardial infarction; however, Spodick sign was obvious in the lateral precordial leads (leads I, aVL, V 4 -V 6 ).…”

mentioning

confidence: 65%

See 1 more Smart Citation

Spotting Spodick Sign in the Diagnostic Dilemma

Wu

¹

,

Yao

²

,

Cao

³

2022

JAMA Intern Med

0

View full text Add to dashboard Cite

To the Editor Dr Alsagaff and colleagues 1 present an interesting and well-documented case of a middle-aged man with pericarditis concurrent with ST elevation myocardial infarction. The case report is excellent; however, we would like to point out a finding on the electrocardiogram (ECG) that deserves further discussion.On the ECG, we noticed Spodick sign, which was not described by Dr Alsagaff and colleagues 1 in the case report. The ECG features of acute pericarditis usually include 4 stages. First, ST segment is elevated in all leads except aVR and V 1 leads; second, the ST segment gradually returns to the baseline, and the T wave flattens; third, there is a T-wave inversion, and potentially, ST-segment depression; and fourth, a return to normal within weeks or months. 2 Although these ECG features are helpful in diagnosing acute pericarditis, Spodick sign is also a useful clue of acute pericarditis and is commonly ignored by physicians. Spodick sign is defined by a downsloping TP segment, which is most clearly seen in lateral precordial leads and lead II. 3 This ECG feature can occur in approximately 80% of patients with acute pericarditis. 3 In this patient case, 1 Spodick sign seems to be masked in the ECG at presentation owing to the fast heart rate and long PR interval. In the patient's follow-up ECG (after rescue percutaneous coronary intervention), the inferior leads evolved after acute myocardial infarction; however, Spodick sign was obvious in the lateral precordial leads (leads I, aVL, V 4 -V 6 ).Spodick sign can also be used to distinguish between acute pericarditis and acute coronary syndrome. A PR-segment depression can be seen in both acute coronary syndrome and acute pericarditis. However, the coexistence of Spodick sign and PR-segment depression often suggests the diagnosis of acute pericarditis. 4 Therefore, Spodick sign is an important diagnostic clue of acute pericarditis, and we need to improve awareness of this ECG feature. Early recognition of Spodick sign is conducive to the timely diagnosis and treatment of acute pericarditis.

show abstract

“…In Reply We would like to express our gratitude to Dr Wu and colleagues for recognizing Spodick sign on the results of a postpercutaneous coronary intervention (PCI) electrocardiogram (ECG) in our case report . Spodick sign is characterized as a downsloping TP segment that is most clearly identified in lead II and the lateral precordial leads.…”

mentioning

confidence: 91%

Spotting Spodick Sign in the Diagnostic Dilemma—Reply

Alsagaff

¹

,

Lusida

²

,

Azmi

³

2022

JAMA Intern Med

Self Cite

0

View full text Add to dashboard Cite

To the Editor Dr Alsagaff and colleagues 1 present an interesting and well-documented case of a middle-aged man with pericarditis concurrent with ST elevation myocardial infarction. The case report is excellent; however, we would like to point out a finding on the electrocardiogram (ECG) that deserves further discussion.On the ECG, we noticed Spodick sign, which was not described by Dr Alsagaff and colleagues 1 in the case report. The ECG features of acute pericarditis usually include 4 stages. First, ST segment is elevated in all leads except aVR and V 1 leads; second, the ST segment gradually returns to the baseline, and the T wave flattens; third, there is a T-wave inversion, and potentially, ST-segment depression; and fourth, a return to normal within weeks or months. 2 Although these ECG features are helpful in diagnosing acute pericarditis, Spodick sign is also a useful clue of acute pericarditis and is commonly ignored by physicians. Spodick sign is defined by a downsloping TP segment, which is most clearly seen in lateral precordial leads and lead II. 3 This ECG feature can occur in approximately 80% of patients with acute pericarditis. 3 In this patient case, 1 Spodick sign seems to be masked in the ECG at presentation owing to the fast heart rate and long PR interval. In the patient's follow-up ECG (after rescue percutaneous coronary intervention), the inferior leads evolved after acute myocardial infarction; however, Spodick sign was obvious in the lateral precordial leads (leads I, aVL, V 4 -V 6 ).Spodick sign can also be used to distinguish between acute pericarditis and acute coronary syndrome. A PR-segment depression can be seen in both acute coronary syndrome and acute pericarditis. However, the coexistence of Spodick sign and PR-segment depression often suggests the diagnosis of acute pericarditis. 4 Therefore, Spodick sign is an important diagnostic clue of acute pericarditis, and we need to improve awareness of this ECG feature. Early recognition of Spodick sign is conducive to the timely diagnosis and treatment of acute pericarditis.

show abstract

“…Early post-infarction pericarditis (EPIP) is caused by inflammation of the injured myocardium and usually reflects a large infarct size [ 1 ]. However, electrocardiographic (ECG) changes due to EPIP, and recurrent myocardial infarction (MI) are sometimes difficult to distinguish [ 2 , 3 ]. Here we describe a case of EPIP wherein detection of bedside friction rub and diffuse but transient ST elevation in the ECG were important for arriving at an accurate diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Serial Electrocardiographic Changes in Early Post-myocardial Infarction Pericarditis

Hirata¹,

Kakazu²,

Arakaki³

et al. 2022

Cureus

0

View full text Add to dashboard Cite

A 72-year-old man developed fever and chest pain, accompanied by an increase in C-reactive protein, four days after successful emergency catheter intervention for an acute wide anterior myocardial infarction (MI). A twelve-lead electrocardiogram (ECG) showed marked ST elevation in leads V1-6, I, and aVL, with reciprocal ST depression in leads II, III, and aVF. Although these ECG changes improved by day three, he developed fever and chest pain on day four, and an ECG at this timepoint showed ST elevation in leads II, III, aVF, and mild worsening of the ST elevation in the anterolateral leads, indicating diffuse ST-segment elevation consistent with acute pericarditis. Despite the presence of a typical friction rub, there was no pericardial effusion on an echocardiogram. No elevation of cardiac enzymes was noted. A diagnosis of early post-infarction pericarditis was made, and the patient was successfully treated with acetaminophen and colchicine. Early post-infarction pericarditis (EPIP), albeit rare in the era of emergency catheter treatment, is important because it may indicate a large transmural infarction and must be differentiated from reinfarction. Fever, chest pain, friction rub, ST elevation in the leads distant from the infarct area, recurrence of ST-segment elevation in the infarct area, and increase in inflammatory markers but not cardiac enzymes were crucial for establishing a diagnosis of EPIP.

show abstract

Diagnostic Dilemma of Pericarditis Concurrent With ST Elevation Myocardial Infarction

Cited by 4 publications

References 9 publications

Spotting Spodick Sign in the Diagnostic Dilemma

Spotting Spodick Sign in the Diagnostic Dilemma

Spotting Spodick Sign in the Diagnostic Dilemma—Reply

Serial Electrocardiographic Changes in Early Post-myocardial Infarction Pericarditis

Contact Info

Product

Resources

About