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By Francis Morris; William Brady; A John Camm

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2/7/2008 12:01:44 PM 40 ABC of Clinical Electrocardiography Acute pericarditis Acute pericarditis is commonly mistaken for acute myocardial infarction as both cause chest pain and ST segment elevation. In pericarditis, however, the ST segment elevation is diffuse rather than localised, often being present in all leads except aVR and V1. The elevated ST segments are concave upwards, rather than convex upwards as seen in acute infarction. Depression of the PR segment may also be seen. ST segment elevation in pericarditis is thought to be due to the associated subepicardial myocarditis.

Lead V4R should be recorded as soon as possible 2/7/2008 12:02:42 PM Acute Myocardial Infarction—Part I 35 in all patients with inferior infarction, as ST segment elevation in right ventricular infarction may be short lived. Right ventricular infarction usually results from occlusion of the right coronary artery proximal to the right ventricular marginal branches, hence its association with inferior infarction. Less commonly, right ventricular infarction is associated with occlusion of the circumflex artery, and if this vessel is dominant there may be an associated inferolateral wall infarction.

2/7/2008 12:04:06 PM Myocardial Ischaemia 43 ST segment depression Typically, myocardial ischaemia gives rise to ST segment depression. The normal ST segment usually blends with the T wave smoothly, making it difficult to determine where the ST segment ends and the T wave starts. One of the first and most subtle changes in the ST segment is flattening of the segment, resulting in a more obvious angle between the ST segment and T wave. More obvious changes comprise ST segment depression that is usually planar (horizontal) or downsloping.

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