Acute myocardial infarction—Part II
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7343.963 (Published 20 April 2002) Cite this as: BMJ 2002;324:963All rapid responses
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Sir
J.Edhouse et al states that the presence of PR segment depression in
pericarditis may be useful in differentiating it from myocardial
infarction.(1) However, both PR segment elevation and depression have
been described in myocardial infarction and they not only indicate the
presence of atrial infarction (2) but can also predict the risk of
supraventricular arrythmias in those patients.(3) Criteria for atrial
infarction have been divided into major and minor and they are PR segment
deviation and abnormal P waves respectively. In atypical history and
ECGs, the appearance of T wave inversion before ST segment normalization
rather than after can be useful in differentiating myocardial infarction
from pericarditis and the differentiation may not be easy as cardiac
enzymes including troponins can be raised in both conditions.
References:
1. June Edhouse, William J Brady, Francis Morris. ABC of clinical
electrocardiography.Acute myocardial infarction Part II .BMJ 2002;324:963-
966
2. Christensen JH, Nielsen FE, Falstie-Jensen N et al. Interobserver
variation in interpretation of electrocardiographic signs of atrial
infarction. Clin Cardiol 1993;16(8):603-6.
3. Nielsen FE, Andersen HH, Gram-Hansen P et al. The relationship
between ECG signs of atrial infarction and the development of
supraventricular arrhythmias in patients with acute myocardial infarction.
Am Heart J 1992;123(1):69-72.
Competing interests: None
Competing interests: No competing interests
Useful information for non-cardiologists
It had always been a bug bear making an ecg diagnosis of myocardial
infarction with left bundle branch block. This article had given practical
tips of making the distinction easy. Moreover, points such as masking of
posterior infarction by RBBB and facts about Brugado's syndrome are
clinically stimulating and intersting for non-cardiologists like me.
Competing interests: No competing interests