Clinical presentation
28-year-old man presenting with sharp retrosternal chest pain radiating to the left trapezius ridge, relieved by sitting forward, 10 days after an upper respiratory tract infection.
Investigation findings (12-Lead ECG)
12-lead ECG demonstrates sinus tachycardia (104 bpm), widespread concave ('saddle-shaped') ST-segment elevation across leads I, II, aVL, aVF, and V2–V6, concomitant PR-segment depression in leads II and V4–V6, reciprocal ST depression and PR elevation in lead aVR, and downsloping TP segments (Spodick sign).
Final diagnosis
Acute pericarditis
Case discussion
The absence of reciprocal ST depression in leads other than aVR/V1 and the presence of PR depression reliably distinguish Stage 1 acute pericarditis from ST-elevation myocardial infarction.