What is the role of electrocardiography in the workup of constrictive pericarditis?

Updated: Mar 23, 2021
  • Author: William M Edwards, Jr, MD; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

No electrocardiographic signs are diagnostic for constriction. The electrocardiogram in constriction most often shows nonspecific ST-T segment abnormalities. The diagnostician might be tempted to look for findings similar to those in pericarditis. However, chronic pericarditis (sometimes associated with constriction) is not associated with the classic electrocardiographic (ECG) findings seen with acute pericarditis.

Findings of acute pericarditis generally include diffuse concave ST-segment elevation that must be distinguished from other causes of ST elevation with PR depression. In most instances of acute pericarditis, the magnitude of the ST elevation is greater than one fourth of the T-wave height in the lateral V leads. If a history of these findings exists, the later development of constrictive pericarditis should be considered. The above findings are contrasted with the patient with restrictive cardiomyopathy who may have diffuse low-voltage tracings, bundle-branch block, or AV conduction abnormalities.

Over time, even if chronic pericarditis develops, no specific ECG patterns develop. Inverted T waves may persist, or all ECG findings may resolve to normal. In long-standing cases, atrial fibrillation may occur, but this is certainly nonspecific.

If a pericardial effusion develops, a low QRS voltage may be present in the limb and chest leads. This must be distinguished from other causes of low voltage, such as long-standing myocardial infarction (MI), pleural effusion, postoperative state, or various cardiomyopathies.

When electrical alternans (a beat-to-beat cyclic shift in the QRS axis that may also involve the P and T waves) is present, cardiac tamponade must be considered.


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