Widespread, modest, concave ST elevation with PR depression, and the only ST depression in aVR (and V1), where the PR is elevated instead.
Inflamed pericardium irritates the whole surface of the heart, so the ST elevation is everywhere instead of in one territory: I, II, aVF, aVL and V2-V6, usually modest and concave. The atria are irritated too, which pulls the PR segment down in most leads and up in aVR. The only ST depression belongs in aVR and V1. Depression anywhere else, ST elevation in III bigger than in II, or a convex ST all point to an occlusion instead. In V6, an ST height over a quarter of the T wave's height favors pericarditis over early repolarization. And don't let the label talk you out of a chest-pain workup: plenty of occlusions get called pericarditis by the computer.
Each is a standard 12-lead: 2.5 seconds of each lead in four columns, with 10 seconds of lead II along the bottom, drawn to scale (25 mm a second, 10 mm a millivolt). The measurements are under each one.
Concave ST elevation in V2-V5 with a notched J point and tall, slightly lopsided T waves, no reciprocal depression, and a V6 ST under a quarter of its T wave's height. A normal variant, mostly in the young.
ST elevation in II, III and aVF, with reciprocal ST depression in aVL.
Inferior ST elevation under 1 mm, too small for STEMI criteria, with bulky inferior T waves and the giveaway: ST depression and an inverted T in aVL, the one lead that looks straight back at the inferior wall.
ST elevation across V1-V6 and in I and aVL, with reciprocal depression in III and aVF.
The ECG tool in the app gives you a new 12-lead every time and walks you through reading it: rate, QRS, axis, then where the ST is up and down. It's part of the Paramedic level, and you can try 5 ECGs a day free.
Try the 12-lead drill
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