50-year-old man with waxing and waning chest pain for 12 hours
Answer & Explanation
The clinical history and this EKG were sufficient for the consideration of acute pericarditis. There is the suggestion of inferior-lateral ST-segment elevation, but notice the following…
1. The ST-segment elevation, when closely scrutinized, is partly due to PR-segment change from the baseline. This is most clearly seen in leads II and I as PR depression. There is also PR-segment elevation in lead aVR, an additional described sign of pericarditis.
2. In the lead II rhythm strip there is downward trending of the T-P baseline, also known as Spodick’s sign.
Spodick’s sign of pericarditis
3. ST-segment elevation in lead III > ST elevation in II suggests acute ischemia.
LeWinter MM. Percarditis – clinical review. NEJM 371:2410-16, 2014.