Pericardial Disease

This will be a brief section covering the typical presentation of pericardial diseases on the ECG.

This will include discussions on:

• Acute pericarditis: which typically presents with diffuse ST elevation with PR-ST discordance and has a well-described pattern of evolution. We describe the pathophysiologic mechanisms behind these changes, such as injury vectors and involvement of atrial and ventricular myocardium. We will also discuss how to differentiate acute pericarditis from similar ECG presentations, such as benign early repolarization and myocardial ischemia. We will also describe how superimposed myocarditis may present as well.

• Pericardial effusion and tamponade: which typically presents with low voltage QRS complexes and evidence of electrical alternans. We will provide a differential diagnosis for the sign of electrical alternans, such as respiratory variation and pseudoelectrical alternans from supraventricular tachycardias.