PR Segment Shift in Pericarditis
Report:
Sinus rhythm 88/min
PR segment shift consistent with pericarditis (best seen in leads 1, 2, aVR and V2)
Minimal ST elevation 2, 3, aVF
Comment:
The computer reported minimal ST segment elevation in the inferior leads, but I thought I knew better – it was the PR segment shift that made the ST segment look elevated. The T-P segment is the true baseline.
I was rather pleased to see shallow T wave inversion in her next ECG, consistent with pericarditis (133a). However, the PR segments were unchanged. I made the right diagnosis for the wrong reason!
By then I checked the patient’s record to make sure. She indeed had pericarditis, manifest as typical pain and a pericardial effusion. Dialysis & uræmic patients often fail to show any ECG signs of pericarditis. Note that the uræmic pericarditis is a different entity from the dialysis one97.
What, then, of those PR segments? Looking more closely, there is a borderline left atrial abnormality, best seen in the second P in V4 below. This is what done it!
If you have any suggestions for or feedback on this report, please let us know.
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