Acute Pericarditis

The diagnosis is made by meeting 2 of 4 criteria:

  1. Typical symptoms (pleuritic, sharp chest pain relieved when leaning forward)
  2. New pericardial effusion
  3. Presence of friction rub
  4. Typical ECG findings

Differentiating pericarditis from STEMI can be challenging, but features that suggest pericarditis over STEMI include any of the following: diffuse concave up ST elevations without reciprocal changes, PR depression, PR elevation in aVR, ST-elevation in lead II greater than lead III, and Spodick’s sign – down-sloping of the TP segment. It is important to note that the test characteristics of any single electrocardiographic feature is insufficient to rule in/out pericarditis, and that the feature with the highest odds ratio for predicting STEMI is reciprocal ST-depressions.



  1. Wagner GS, Strauss DG. Marriott’s Practical Electrocardiography. 12th ed. Lippincott Williams & Wilkins; 2014.
  2. LeWinter MM. Acute Pericarditis. New England Journal of Medicine. 2017;371(25):349-359.
  3. 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. The Journal of Emergency Medicine. Published online March 2020.