Evaluation of Spodick's Sign and Other Electrocardiographic Findings as Indicators of STEMI and Pericarditis

Witting, Michael D.; Hu, Kami M.; Westreich, Aaron A.; Tewelde, Semhar Z.; Farzad, Ali; Mattu, Amal

doi:10.1016/j.jemermed.2020.01.017

Cited by 17 publications

(16 citation statements)

References 17 publications

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“…This data was collected from a single site and has a small number of pericarditis patients, limiting the accuracy of results and generalizability of findings. Further studies are needed to validate these results [16].…”

Section: Discussionmentioning

confidence: 88%

Spodick’s Sign: A Case Report and Review of Literature

Abdelazeem

Kandah

Borcheni

et al. 2020

Cureus

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Acute pericarditis is commonly diagnosed in patients who present with chest pain. Accurate diagnosis of acute pericarditis is essential because of its relative similarity to ST-elevation myocardial infarction (STEMI) in both clinical presentation and electrocardiogram (EKG) changes. Additionally, troponin elevation is occasionally seen in acute pericarditis due to myocardial involvement (myopericarditis), which makes accurate diagnosis more challenging. A 12-lead EKG remains the most useful diagnostic test in differentiating acute pericarditis from STEMI. Spodick's sign is a less recognized electrocardiographic feature of acute pericarditis and is frequently overlooked by clinicians. We present a case of a 52-year-old male who initially presented with acute onset substernal chest pain. His EKG revealed diffuse subtle ST elevation and downsloping TP segment (Spodick's sign). A coronary angiogram demonstrated normal coronaries which eliminated the possibility of coronary artery disease. In this article, we will discuss how to differentiate between acute pericarditis and myocardial infarction, with a focus on Spodick's sign, amongst other EKG findings suggestive of pericarditis.

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Section: Discussionmentioning

confidence: 88%

Spodick’s Sign: A Case Report and Review of Literature

Abdelazeem

Kandah

Borcheni

et al. 2020

Cureus

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“…Our pericarditis-DLM exhibits several powerful applications. Current ECG features differentiating STEMI from acute pericarditis have low specificity in clinical scenarios [ 43 ]. Our pericarditis-DLM correctly diagnosed 78.9% of pericarditis cases and identified 89.8% of STEMI cases as non-pericarditis ECGs, which may effectively help the differential diagnosis between these two diseases in the ED.…”

Section: Discussionmentioning

confidence: 99%

A Deep Learning Algorithm for Detecting Acute Pericarditis by Electrocardiogram

Liu

Lin

Cheng

et al. 2022

JPM

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(1) Background: Acute pericarditis is often confused with ST-segment elevation myocardial infarction (STEMI) among patients presenting with acute chest pain in the emergency department (ED). Since a deep learning model (DLM) has been validated to accurately identify STEMI cases via 12-lead electrocardiogram (ECG), this study aimed to develop another DLM for the detection of acute pericarditis in the ED. (2) Methods: This study included 128 ECGs from patients with acute pericarditis and 66,633 ECGs from patients visiting the ED between 1 January 2010 and 31 December 2020. The ECGs were randomly allocated based on patients to the training, tuning, and validation sets, at a 3:1:1 ratio. We used raw ECG signals to train a pericarditis-DLM and used traditional ECG features to train a machine learning model. A human–machine competition was conducted using a subset of the validation set, and the performance of the Philips automatic algorithm was also compared. STEMI cases in the validation set were extracted to analyze the DLM ability of differential diagnosis between acute pericarditis and STEMI using ECG. We also followed the hospitalization events in non-pericarditis cases to explore the meaning of false-positive predictions. (3) Results: The pericarditis-DLM exceeded the performance of all participating human experts and algorithms based on traditional ECG features in the human–machine competition. In the validation set, the pericarditis-DLM could detect acute pericarditis with an area under the receiver operating characteristic curve (AUC) of 0.954, a sensitivity of 78.9%, and a specificity of 97.7%. However, our pericarditis-DLM also misinterpreted 10.2% of STEMI ECGs as pericarditis cases. Therefore, we generated an integrating strategy combining pericarditis-DLM and a previously developed STEMI-DLM, which provided a sensitivity of 73.7% and specificity of 99.4%, to identify acute pericarditis in patients with chest pains. Compared to the true-negative cases, patients with false-positive results using this strategy were associated with higher risk of hospitalization within 3 days due to cardiac disorders (hazard ratio (HR): 8.09; 95% confidence interval (CI): 3.99 to 16.39). (4) Conclusions: The AI-enhanced algorithm may be a powerful tool to assist clinicians in the early detection of acute pericarditis and differentiate it from STEMI using 12-lead ECGs.

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“…Por lo general, no hay cambios durante la despolarización, por lo tanto, en ausencia de una enfermedad cardíaca subyacente, la onda P y los complejos QRS son normales. La depresión del segmento PR es muy específica de la pericarditis aguda y se atribuye a una lesión auricular subepicárdica, y ocurre en todas las derivaciones excepto en aVR y V1; estas derivaciones pueden presentar elevación del segmento PR [9,10]. El signo de Spodick es un segmento TP descendente y está presente en aproximadamente el 80% de los pacientes afectados por pericarditis aguda, este suele visualizarse mejor en la derivación II y en las derivaciones precordiales laterales, y puede servir como una importante herramienta electrocardiográfica para distinguir entre la pericarditis aguda y el síndrome coronario agudo (figura 1).…”

Section: Discussionunclassified

Signo de Spodick: ¿aliado o enemigo?

Puerta-Rojas

Forero-Saldarriaga

Moreno-Ruiz³

et al. 2022

Med. Lab.

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La pericarditis se refiere a la inflamación de las capas del pericardio y es la forma más común de enfermedad pericárdica. Puede estar asociada a derrame pericárdico y resultar en un taponamiento. La enfermedad puede ser una condición aislada o una manifestación cardíaca de un trastorno sistémico (por ejemplo, enfermedades autoinmunes o autoinflamatorias). La pericarditis se categoriza como aguda, incesante, recurrente o crónica, pero se debe tener en cuenta que también se clasifica como de etiología infecciosa y no infecciosa, siendo la presentación idiopática la más común.

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Evaluation of Spodick's Sign and Other Electrocardiographic Findings as Indicators of STEMI and Pericarditis

Cited by 17 publications

References 17 publications

Spodick’s Sign: A Case Report and Review of Literature

Spodick’s Sign: A Case Report and Review of Literature

A Deep Learning Algorithm for Detecting Acute Pericarditis by Electrocardiogram

Signo de Spodick: ¿aliado o enemigo?

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