Pericarditis – T Wave Stage (Stage III)

Report:

Sinus rhythm

Nonspecific T wave changes

Possible LVH

RV6 > RV5

Comment:

There is nothing to specifically point to pericarditis as the cause of this young man’s T wave flattening and inversion, but it is perfectly consistent with that diagnosis. As Spodick himself puts it, “if the ECG is first recorded in Stage III, pericarditis cannot be diagnosed on ECG grounds…”126

History of pleuritic pain and finding of left pleural effusion and pericardial thickening on the CAT scan make the multitude of alternative diagnoses unlikely.

In more formal times, nephritis was classified as Ellis 1 or Ellis 2 type; similarly, pericarditis had its ST stage and its T wave stage. This would have been a good example of T wave stage of pericarditis. Modern classification is more detailed127, but remains well ahead of what happened to nephritis!

It is unusual for the pain to persis over a fortnight but the presumed inflammation had not been treated, either.

The T waves may remain inverted indefinitely. Below (Fig 171a) is a routine preoperative tracing in a 33 year old woman who, on questioning after the ECG was taken, revealed an episode of central pleuritic chest pain two years previously. Again, her widespread T wave inversion and flattening is quite non-specific, but quite in keeping with a past pericarditis. Characteristically, the inverted T waves are small and shallow.