ECG Findings in Pericarditis

Classic ECG Patterns

The European Society of Cardiology recommends considering ECG changes, including widespread ST-segment elevation and PR-segment depression, as characteristic findings in pericarditis, although they are present in only about 60% of cases, in patients such as a 31-year-old female with left-sided chest pain and left shoulder pain 1, 2
Changes are typically widespread rather than localized to a specific coronary territory, reflecting inflammation of the epicardium rather than the pericardium itself, in patients with pericarditis 1

The European Heart Society suggests obtaining immediate ECG looking specifically for widespread ST elevation and PR depression in patients with suspected pericarditis, such as a 31-year-old female with left-sided chest pain and left shoulder pain 1
The European Society of Cardiology recommends applying the ESC diagnostic criteria, which includes pericarditic chest pain, pericardial friction rub, new widespread ST-elevation or PR depression on ECG, and pericardial effusion, for diagnosing pericarditis 1, 2
Checking inflammatory markers, such as CRP, ESR, and WBC, and cardiac troponins is recommended in patients with suspected pericarditis 1

The European Society of Cardiology notes that left shoulder pain is a classical feature of pericarditis, but left arm pain raises concern for myocardial involvement or acute coronary syndrome, and recommends considering concurrent myocarditis if ECG changes are present, especially if troponin is elevated 3
Pericarditis pain is typically sharp, pleuritic, and improves sitting forward, radiating to the neck, back, or left shoulder, whereas MI pain is associated with convex ST elevation in specific coronary distributions 3

Cardiac MRI is the most sensitive study for confirming myocardial and pericardial inflammation when the diagnosis is uncertain or myocardial involvement is suspected, with a sensitivity of 94-100% 3