CARDIOVASCULAR MEDICINE

What are the typical ECG changes in acute pericarditis?

Stage 1: diffuse ST elevation + PR depression

Stage 2: ST segments return toward normal

Stage 3: T-wave inversion

Stage 4: ECG returns to baseline

Why might dobutamine be used instead of adrenaline in low cardiac output?

• Dobutamine is mainly a β₁ agonist → ↑ contractility → ↑ cardiac output, with less vasoconstriction. Adrenaline also causes α₁ vasoconstriction → ↑ afterload and myocardial oxygen demand

What are the commonest causes of heart failure in sub-Saharan Africa according to THESUS-HF?

1. Hypertensive heart disease

2. Cardiomyopathy

3. Ischaemic heart disease

Do all patients with pericarditis go through all four ECG stages?

No. Not all patients demonstrate all four stages, and the ECG manifestations can vary

How does the distribution of ST elevation differ between pericarditis and myocardial infarction?

• Pericarditis: typically diffuse

• Myocardial infarction: typically localized to a coronary territory

What are the ECG features of Stage 1 pericarditis?

• Diffuse ST-segment elevation

• PR-segment depression

• ST depression in aVR and V1

What happens to the ECG in Stage 4?

The ECG gradually returns to the patient’s pre-pericarditis baseline, usually over weeks to months

What happens to the ST segments in Stage 2?

The ST segments return toward the baseline, usually within about 1 week.

What happens to the T waves in Stage 3?

T-wave inversion develops

What are the causes of secondary hypertension?

• Renal disease

• Renovascular disease

• Primary hyperaldosteronism

• Phaeochromocytoma

• Cushing syndrome

• Thyroid disease

• Coarctation of the aorta

• Obstructive sleep apnoea

• Pregnancy-related hypertension

• Drugs and substances, e.g. NSAIDs, steroids, oral contraceptives, sympathomimetics

• Hyperparathyroidism

• Acromegaly

• Mineralocorticoid excess syndromes

Is a characteristic ECG always present in uremic pericarditis?

No. Uremic pericarditis may lack the characteristic ECG changes.

What are the causes of ST-segment elevation on ECG?

• Acute myocardial infarction (STEMI)

• Acute pericarditis

• Benign early repolarisation

• Coronary vasospasm (Prinzmetal angina)

• Left ventricular aneurysm

• Myocarditis

• Takotsubo cardiomyopathy

• Brugada syndrome

• Hyperkalaemia

• Pulmonary embolism, occasionally

• Aortic dissection involving a coronary artery, rarely

What happens to the T waves in Stage 3?

T-wave inversion develops

What happens to the ST segments in Stage 2?

The ST segments return toward the baseline, usually within about 1 week