STEMI vs Pericarditis
- Think STEMI if: Reciprical STD (except V1 or aVR), STE in III > II, horizontal or convex upwards STE, new Q waves, check mark sign (T wave takes off directly from S wave, no real ST segment).
- Think pericarditis if: PR depression in multiple leads, PR elevation in aVR, Spodick’s sign (downsloping TP segment)
- Concordant ST elevation > 1mm or concordant ST depression >1mm V1-V3 - 90 % specific
- Excessively discordant (>5mm discordant ST change or if ST change >25% S wave) – sensitive but not specific!
- Only need one lead, do not need two contiguous leads
- Commonly misdiagnosed as Guillain Barre Syndrome
- Most common in females <8 yo with long hair in April-June
- Presents with ascending flaccid paralysis, hyporeflexia, sensory sparing