2018 / 15 January

Electrocardiographic Manifestations of Acute Pericarditis

Classical findings of Pericarditis in ECG are:

  • Diffuse ST-segment elevation and PR-segment depression
  • ST-segment depression in aVR or V1
  • Low voltage, classically defined as total amplitude of the QRS complex less than 0.5 mv in the limb leads and less than 1 mv in the precordial leads
  • Absence of reciprocal ST-segment changes

For more ECG changes, check Pericarditis on LITFL

Pericarditis can be associated with pericardial effusion. Massive pericardial effusion produces a triad of:

  • Low QRS voltage
  • Tachycardia
  • Electrical alternans

Pericardial tamponade is a life-threatening medical condition caused by the accumulation of fluid, blood, pus, or air in the pericardial space, which lead hemodynamic compromise due to reducing ventricular filling. Findings during physical examination are included in Beck´s triad (Hypotension with a Narrowed Pulse Pressure,Jugular Venous Distention and Muffled heart Sounds) and pulsus paradoxus.


  • Parvez N, Carpenter JL. Cardiac tamponade in Still disease: a review of the literature. South Med J. 2009 Aug. 102(8):832-7.
  • Reddy PS, Curtiss EI, O’Toole JD, Shaver JA. Cardiac tamponade: hemodynamic observations in man. Circulation 1978; 58:265.
  • Permanyer-Miralda G. Acute pericardial disease: approach to the aetiologic diagnosis. Heart 2004; 90:252.
  • Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet 2004; 363:717.

Further reading:

Cardiac tamponade: a clinical challenge

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