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EKG Signs of Cardiac Diseases

A) Pericardial disease:

*Constrictive pericarditis:

›› Flat or inverted T-waves in almost all cased. The depth of the T-wave inversion is roughly proportional to the precordial adherence and thus operative difficult
›› Atrial fibrillation is common
›› If sinus rhythm is present, P-waves are often abnormal
›› Low voltage is present in 60% of cases

Pericardial effusion:

›› Low voltage
›› Electrical alternans
›› ST -segment elevation (as in pericarditis)

Click here to see result

*Acute Pericarditis:
The EKG expression depends on the stage of pericarditis.


›› ST-segment elevation with upward concavity of the ST - segment in many leads without reciprocal changes seen with acute myocardial infarction
›› The ST segment elevation can be seen in all leads except aVR and rarely in V1
›› ST-segment depression is common in the aVR and sometimes in V1
›› These changes usually last for many (approx. 10-14) days.

T-wave stage

›› T-wave inversion in many leads with isoelectric ST-segment. This usually lasts for 10-14 days
›› ST-elevation and T-wave inversion do not occur together in pericarditis
›› Low voltage may also be present
›› PR-segment depression (pathognomonic) can be seen only in single leads.

Comparative EKG changes between Myocardial ischemia and Pericarditis


Points Myocardial ischemia Pericarditis
Lead changes  Regional Non-regional
ST-elevation convex upward concave upward
T-wave inversion Before returning of ST-segment (isoelectric) After returning of ST-segment (isoelectric)
Reciprocal ST- depression Common in any leads Only in aVR and V1
Q-wave Present Absent
EKG changes Lasts longer Reverses in days
Atrial fibrillation Uncommon Common

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›› May manifest the changes seen in pericarditis
›› Pathological Q-wave may be seen due to myocardial necrosis
›› Conduction system delay or blocks can develop
››  If the inflammatory process involves the atria - abnormal atrial morphologies can be seen
››  In case of heart failure complicating the myocarditis, evidence of volume overload can also be demonstrated

Common EKG manifestations of acute myocarditis are:

›› Low voltage
›› QRS prolongation
›› ST -segment elevation or depression
›› T-wave inversion
›› QT prolongation
›› Both supra- ventricular and ventricular arrhythmias are common, however non-specific


A) Hypertrophic cardiomyopathy:

›› The most common EKG pattern in hypertrophic cardiomyopathy is LVH and strain
›› In asymmetrical septal hypertrophy (ASH), and abnormal septal depolarization may be detected by the presence of abnormal deep Q-waves in leads I, aVL, V5 and V6 and tall initial R wave in V1.

B)Congestive cardiomyopathy:

›› Congestive cardiomyopathy is manifested with non-specific intra-ventricular conduction abnormalities, these include broad, notched QRS complex
›› Non-specific ST, T-wave changes are common

C)Restrictive Cardiomyopathy:

The EKG can demonstrate the following:
›› Low voltage tracing
›› Intraventricular conduction delay
›› Loss of R-wave progression across the precordium

Click here to see result