Slide 1: 60yo M. NSTEMI 1 week ago. Now with persistent CP and this EKG. [EKG] What’s your treatment?

Slide 2: Aspirin…because our diagnosis is: Pericarditis s/p MI.

Slide 3: Pericarditis on EKG: It’s all in the ST segment.

  • Pericarditis:
    • ST must be concave/upsloping.
    • STD can only be in aVR and V1.
    • ST height to T height > 1 to 4.
  • STEMI:
    • ST can be concave or convex.
    • STD can be in any leads.
    • ST height to T height = any ratio.
  • Benign early repol:
    • ST must be concave.
    • Should not see STD.
    • ST height to T height < 1 to 4.
    • J point: fish-hook pattern in V4!

Slide 4: Today’s Pearl. Acute pericarditis + recent MI = one option. Acute anti-inflammatory treatment with high dose aspirin is the indicated treatment of choice. Thinking indomethacin? Think again! NSAIDs can impair scar formation post myocardial infarction. What about other anti-inflammatory measures? Colchicine is an effective adjunctive to anti-inflammatory medications to reduce risk of recurrent pericarditis. Steroids are reserved for patients with refractory acute pericarditis or with contraindication to anti-inflammatory treatments.


  • Lotrionte M, et al. International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences. Am Heart J. 2010 Oct;160(4):662-70. PMID 20934560

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