Electrocardiographic evolution during acute pericarditis

Patient

28-year-old woman hospitalized for increasing chest pain on inspiration since approximately 3 hours;

Trace

This tracing shows a diffuse elevation (present in lead I, inferior leads and precordial leads from V3 to V6), ascending, concave upwards in its initial portion, followed by high-amplitude T-waves; modest depression in V1 and aVR; Biological and ultrasound assessment confirmed the diagnosis of acute pericarditis probably of viral origin; initiation of high-dose anti-inflammatory therapy.

Trace

Recorded the next day (D1); reduction in the amplitude of the elevation and the size of the T-waves;

Trace

Recorded the day after (D2); the elevation has disappeared; flattening and inversion of T-waves;

Exergue

Even though the sequence is not always as characteristic, it is common to observe 4 phases in the evolution of electrocardiographic changes during acute pericarditis: an initial phase with diffuse ST-segment elevation (more or less associated with a PQ segment depression), a transition phase with isoelectric return and T-wave flattening, a relatively constant phase of T-wave inversion followed by a remission phase with normalization of the electrocardiogram.