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June 11, 2003

Electrocardiographic Diagnosis of Pericarditis

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(22):2942-2943. doi:10.1001/jama.289.22.2942-a

In Reply: I agree with Dr Mansi that in a few cases stage 1 acute pericarditis may be indistinguishable from early repolarization.1 However, apart from any different clinical syndromes, there are numerous ECG criteria that usually distinguish between them. These include the degree and ubiquity of PR segment deviations.2 Furthermore, marked and widespread PR depressions (such as were shown in the Figure 1 in my article) are never observed in early repolarization.2 However, sometimes only ST (J point) deviations occur in acute pericarditis without PR deviations and these may resemble those observed in early repolarization.1,3 Still, in such ECGs and in nearly all patients with acute pericarditis, the J point height in lead V6 measures more than 25% of the height of the T peak from the baseline.4 Thus, there are several reasons that the ECG in my article is clearly diagnostic of acute pericarditis.4

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