ST Segment Depression in Pericarditis

Report:

Sinus rhythm 84/min

Borderline left atrial abnormality

Left ventricular hypertrophy voltage

ST segment elevation c/c pericarditis

Comment:

Even with a somewhat wobbly baseline, there is ST depression in V1. This is not a true reciprocal change: it is isolated and the rest of the trace is typical of acute pericarditis. This is quite common in pericarditis, a feature of rS complexes in the frontal leads, too, when present. Sometimes, like in Case 35, such leads merely do not participate in ST elevation.

The proof that the repolarisation changes are due to pericarditis (in reality, epicarditis, since pericardium is electrically silent) is the trace taken two days later, virtually unchanged (Fig 60a).

The LVH voltage with its associated LAA indicates that other, older cardiac pathology may exist here. I looked up the patient’s records: he had mitral valve prolapse with incompetence severe enough to cause pulmonary hypertension, and was booked for MVR. The LVH here is of the volume overload type, with T waves still upright (they may have been large once). Another feature of mitral incompetence LVH (from somewhere in Schamroth) is relatively small S wave in V1.

Thus it came as no surprise when, a few days later, he developed AF (Fig 60b). Pericarditis per se does not cause atrial arrhythmias47.