Abstract
Background
Patients with ST elevation on electrocardiogram (ECG) could have ST elevation myocardial
infarction (STEMI) or pericarditis. Spodick's sign, a downsloping of the ECG baseline
(the T-P segment), has been described, but not validated, as a sign of pericarditis.
Objective
This study estimates the frequency of Spodick's sign and other findings in patients
diagnosed with STEMI and those with pericarditis.
Methods
In this retrospective review, we selected charts that met prospective definitions
of STEMI (cases) and pericarditis (controls). We excluded patients whose ECGs lacked
ST elevation. An authority on electrocardiography reviewed all ECGs, noting the presence
or absence of Spodick's sign, ST depression (in leads besides V1 and aVR), PR depression, greater ST elevation in lead III than in lead II (III > II),
abrupt take-off of ST segment (the RT checkmark sign), and upward or horizontal ST
convexity. We quantified strength of association using odds ratio (OR) with 95% confidence
interval (CI).
Results
One hundred and sixty-five patients met criteria for STEMI and 42 met those for pericarditis.
Spodick's sign occurred in 5% of patients with STEMI (95% CI 3–10%) and 29% of patients
with pericarditis (95% CI 16–45%). All other findings statistically distinguished
STEMI from pericarditis, but ST depression (OR 31), III > II (OR 21), and absence
of PR depression (OR 12) had the greatest OR values.
Conclusions
Spodick's sign is statistically associated with pericarditis, but it is seen in 5%
of patients with STEMI. Among other findings, ST depression, III > II, and absence
of PR depression were the most discriminating.
Keywords
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Article info
Publication history
Published online: March 25, 2020
Accepted:
January 20,
2020
Received in revised form:
January 6,
2020
Received:
August 17,
2019
Footnotes
Presented at the Society for Academic Emergency Medicine Mid-Atlantic Regional Meeting, Washington, DC, March 2019, and the Society for Academic Emergency Medicine Annual Meeting, Las Vegas, NV, May 2019.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
