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7183394 
Journal Article 
PR depression with multi‑lead ST elevation and ST depression in aVR: Is it always acute pericarditis? 
Birnbaum, Y; Perez Riera, AR; Nikus, K; , 
2019 
Yes 
Journal of Electrocardiology
ISSN: 0022-0736
EISSN: 1532-8430 
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS 
PHILADELPHIA 
13-17 
English 
30802680 
WOS:000471737700004 
The classic electrocardiographic (ECG) manifestation of stage I of acute pericarditis is diffuse ST elevation and PR depression with ST depression in lead aVR. One of the most common conditions, that is often confused with acute pericarditis, is the benign diffuse ST elevation, termed "early repolarization with ST elevation" (ERSTE). ERSTE often presents with diffuse ST elevation in the inferior and anterolateral leads, with or without terminal QRS notching or slurring. As ERSTE often presents with ST elevation in leads I and II, frequently there is concomitant ST depression in lead aVR, similar to the acute pericarditis ECG pattern. Moreover, PR depression in the inferior leads and/or PR elevation in lead aVR is often seen. Here we describe four patients with ERSTE, all had ST elevation in II with either ST elevation or isoelectric ST in lead I and concomitant ST depression in aVR. Two also had PR depression in the inferior leads. None of the patients had clinical symptoms or signs of acute pericarditis. In conclusion, diffuse ST elevation in the inferolateral leads associated with ST depression in aVR and even with PR segment depression is commonly found in ERSTE and should not be considered as pathognomonic of only acute pericarditis.