Understanding Stemis and Acute Pericarditis: Differentiating the Two

🔍When evaluating a possible stemi or acute pericarditis, ignore AVR and V1 and look for ST depression in the other 10 leads. If ST depression is present, it's likely a stemi.

📊Compare ST elevation in lead 3 to lead 2. If lead 3 has greater elevation, it indicates a stemi. If lead 2 has greater elevation, consider acute pericarditis.

📈Look for horizontal or convex upward ST elevation. Horizontal or convex elevation is indicative of a stemi, while concave elevation suggests acute pericarditis.

❓PR segment changes, such as elevation in AVR, can be found in both stemis and acute pericarditis. Therefore, PR segment changes alone are not reliable for diagnosis.

🔄In cases where the diagnosis is uncertain, continue to monitor and obtain serial EKGs. Changes over time can help differentiate between stemis and acute pericarditis.

Are Q waves a reliable indicator of a stemi?

—Q waves are not always reliable and should be interpreted with caution. Only new Q waves are significant in determining a stemi.

Can PR segment changes help differentiate between stemis and acute pericarditis?

—PR segment changes, such as PR elevation in AVR, can be found in both stemis and acute pericarditis. Therefore, PR segment changes alone are not reliable for diagnosis.

What should be done in cases where the diagnosis is uncertain?

—In cases where the diagnosis is uncertain, continue to monitor the patient and obtain serial EKGs. Changes in EKG findings over time can help differentiate between stemis and acute pericarditis.

Can ST depression be seen in acute pericarditis?

—ST depression is more commonly seen in stemis rather than acute pericarditis. However, it is not completely absent from cases of acute pericarditis.

Is horizontal ST elevation always indicative of a stemi?

—Horizontal or convex upward ST elevation is indicative of a stemi. However, it should be noted that pericarditis can also cause horizontal ST elevation in some cases.

00:00This video discusses the differentiation between stemis and acute pericarditis based on EKG findings.

03:28Ignore AVR and V1 and look for ST depression in the other 10 leads. ST depression is more commonly seen in stemis.

04:20Compare ST elevation in lead 3 to lead 2. If lead 3 has greater elevation, it indicates a stemi.

05:43Look for horizontal or convex upward ST elevation, which is indicative of a stemi.

07:50PR segment changes, such as elevation in AVR, can be found in both stemis and acute pericarditis. Therefore, they should not be relied upon for diagnosis.

09:15In cases where the diagnosis is uncertain, continue to monitor and obtain serial EKGs.