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At Cardiac Bootcamp we look at ischaemia on ECG and go over how to differentiate it from Pericarditis or Benign Early Repolarisation.

Follow these 4 rules to increase your chances of picking up ischaemia. See the examples below.

A 38 yo patient presents with chest pain. The ECG is shown below.
​Is this ischaemia, pericarditis or benign early repolarisation(BER)?

Let’s answer the 4 questions. This ECG is not a straight-forward rule in.

  1. Is there ST depression in any lead other than aVR and V1
    1. There may potentially be some ST depression in III- This could be ischaemia
    2. There is also some PR depression, which may point to pericarditis
  2. Is STE III>II
    1. No
    2. There is some STE in I, aVL, II, V4-V6- Too many territories to be ischaemia
  3. Is there a QRT Sign or a convex segment
    1. No
  4. Are there hyperacute T waves
    1. No
This is probably not an ischaemic ECG. Can we rule in Pericarditis or BER next?

Changes that make Pericarditis more likely than BER:

  1. No fish hook, ie., J point, especially in V4
  2. (Spodick’s Sign: There is a downslope of the ST-T segment.)
  3. ​ST segment elevation/T wave in V6 is >0.25
The diagnosis is pericarditis.

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