Acute pericarditis (ECG pattern)
Also calledPericarditis · Acute pericarditis EKG · Diffuse ST elevation with PR depression · Stage 1 pericarditis
Definition
The defining feature is diffuse ST-segment elevation spread across more than one region rather than one coronary territory (often in all leads except aVR and V1), concave upward in shape and classically accompanied by widespread PR-segment depression. Leads aVR and V1, which face the ventricular cavity, record ST depression instead. Unlike STEMI, there is no widespread reciprocal ST depression and there are no Q waves; ST depression in leads other than aVR and V1 points toward STEMI. A Spodick sign (downsloping TP segment) may be seen; in one study it was present in 29 percent of patients with pericarditis and 5 percent with STEMI. In the original Ginzton-Laks study, a ratio of ST-segment onset amplitude to T-wave amplitude of 0.25 or more in lead V6 separated pericarditis from normal-variant ST elevation (benign early repolarization). The pattern classically evolves through four stages: diffuse ST elevation and/or PR depression, then normalization of the ST and PR segments, then diffuse T-wave inversion, then a normal ECG.
Clinical noteTypical ECG changes are reported in only up to about 60 percent of cases, and their evolution varies widely from patient to patient. ECG change is only one of the four diagnostic criteria, of which two are needed, so pericarditis can be diagnosed without it.
Sources
- Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015;36(42):2921-2964. doi.org/10.1093/eurheartj/ehv318
- Ginzton LE, Laks MM. The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria. Circulation. 1982;65(5):1004-1009. doi.org/10.1161/01.cir.65.5.1004
- Masek KP, Levis JT. ECG diagnosis: acute pericarditis. Perm J. 2013;17(4):e146. doi.org/10.7812/TPP/13-044
- Edhouse J, Brady WJ, Morris F. ABC of clinical electrocardiography: acute myocardial infarction, part II. BMJ. 2002;324(7343):963-966. doi.org/10.1136/bmj.324.7343.963
- Wagner GS, Macfarlane P, Wellens H, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part VI: acute ischemia/infarction. Circulation. 2009;119(10):e262-e270. doi.org/10.1161/CIRCULATIONAHA.108.191098
- Witting MD, Hu KM, Westreich AA, Tewelde S, Farzad A, Mattu A. Evaluation of Spodick's sign and other electrocardiographic findings as indicators of STEMI and pericarditis. J Emerg Med. 2020;58(4):562-569. doi.org/10.1016/j.jemermed.2020.01.017
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.