New electrocardiographic criteria to differentiate acute pericarditis and myocardial infarction
| Autor: | Xavier Rossello, Rob F. Wiegerinck, Andreu Ferrero, Alfredo Bardají, Mario Sutil, Juan Cinca, Joan Alguersuari, Fernando Worner |
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| Předmět: |
Adult
QT interval medicine.medical_specialty humanos Myocardial Infarction pericarditis Pericarditis QRS complex Electrocardiography Acute pericarditis Heart Conduction System enfermedad aguda Internal medicine Diagnosis medicine ST segment Humans cardiovascular diseases mediana edad infarto de miocardio Aged Medicine(all) anciano medicine.diagnostic_test business.industry sistema de conducción cardíaco General Medicine Middle Aged adulto medicine.disease diagnóstico Myocardial infarction Acute Disease Cardiology Myocardial infarction diagnosis Electrical conduction system of the heart business electrocardiografía |
| Zdroj: | Recercat. Dipósit de la Recerca de Catalunya instname AMERICAN JOURNAL OF MEDICINE r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau Repositorio Abierto de la UdL Universitad de Lleida |
| ISSN: | 0002-9343 |
| Popis: | 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. This work was supported by a grant from the Spanish Ministry of Science and Innovation, Redes de Investigacion del Instituto de Salud Carlos III [REDINSCOR RD06/0003], and Fondo Europeo de Desarrollo Regional (FEDER). |
| Databáze: | OpenAIRE |
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