New Electrocardiographic Criteria to Differentiate Acute Pericarditis and Myocardial Infarction

OBJECTIVE: Transmural myocardial ischemia induces changes in QRS complex and QT interval duration but, theoretically, these changes might not occur in acute pericarditis provided that the injury is not transmural. This study aims to assess whether QRS and QT duration permit distinguishing acute peri...

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Detalles Bibliográficos
Autores: Rosselló, Xavier, Wiegerinck, Rob F., Alguersuari, Joan, Bardaji, Alfredo, Worner, Fernando, Sutil, Mario, Ferrero, Andreu, Cinca, Juan
Tipo de recurso: artículo
Fecha de publicación:2014
País:España
Institución:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/17374
Acceso en línea:https://hdl.handle.net/20.500.13003/17374
Access Level:acceso abierto
Palabra clave:Pericarditis
Female
Biomarkers
Male
Myocardial Infarction
Middle Aged
Electrocardiography
Humans
Heart Conduction System
Adult
Acute Disease
Diagnosis, Differential
Aged
Diagnóstico Diferencial
Biomarcadores
Femenino
Infarto del Miocardio
Masculino
Electrocardiografía
Sistema de Conducción Cardíaco
Humanos
Persona de Mediana Edad
Anciano
Adulto
Enfermedad Aguda
Myocardial infarction
QRS complex
QT interval
ST segment
Descripción
Sumario:OBJECTIVE: Transmural myocardial ischemia induces changes in QRS complex and QT interval duration but, theoretically, these changes might not occur in acute pericarditis provided that the injury is not transmural. This study aims to assess whether QRS and QT duration permit distinguishing acute pericarditis and acute transmural myocardial ischemia. METHODS: Clinical records and 12-lead electrocardiogram (ECG) at x 2 magnification were analyzed in 79 patients with acute pericarditis and in 71 with acute ST-segment elevation myocardial infarction (STEMI). RESULTS: ECG leads with maximal ST-segment elevation showed longer QRS complex and shorter QT interval than leads with isoelectric ST segment in patients with STEMI (QRS: 85.9 +/- 13.6 ms vs 81.3 +/- 10.4 ms, P = .01; QT: 364.4 +/- 38.6 vs 370.9 +/- 37.0 ms, P = .04), but not in patients with pericarditis (QRS: 81.5 +/- 12.5 ms vs 81.0 +/- 7.9 ms, P = .69; QT: 347.9 +/- 32.4 vs 347.3 +/- 35.1 ms, P = .83). QT interval dispersion among the 12-ECG leads was greater in STEMI than in patients with pericarditis (69.8 +/- 20.8 ms vs 50.6 +/- 20.2 ms, P < .001). The diagnostic yield of classical ECG criteria (PR deviation and J point level in lead aVR and the number of leads with ST-segment elevation, ST-segment depression, and PR-segment depression) increased significantly (P = .012) when the QRS and QT changes were added to the diagnostic algorithm. CONCLUSIONS: Patients with acute STEMI, but not those with acute pericarditis, show prolongation of QRS complex and shortening of QT interval in ECG leads with ST-segment elevation. These new findings may improve the differential diagnostic yield of the classical ECG criteria.

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