PR depression is useful in the differential diagnosis of myopericarditis and ST elevation myocardial infarction
Annals of Noninvasive Electrocardiology, 05/21/2012
Porela P et al. – These present observations show that PR segment analysis is a powerful tool in the differential diagnosis of myopericarditis and ST elevation myocardial infarction (STEMI). This simple information should be added to the diagnostic workup of patients presenting with ST elevations.Methods
- 34 consecutive patients with acute myopericarditis and 46 STEMI patients presenting with ST elevations fulfilling the criteria for STEMI were included.
- The first ECG recorded in the emergency room was analyzed with a focus on the PR segment.
- The diagnoses of myopericarditis and STEMI were ascertained with clinical follow–up together with rise in troponin levels, and in the STEMI patients also with coronary angiography.
- In myopericarditis, the most common location for PR depression was lead II (55.9%), while this ECG finding least likely appeared in lead aVL (2.9%).
- PR depression in any lead had a high sensitivity (88.2%), but fairly low specificity (78.3%) for myopericarditis.
- The combination of PR depressions in both precordial and limb leads had the most favorable predictive power to differentiate myopericarditis from STEMI (positive 96.7% and negative power 90%).