Differential Characteristics of the Electrocardiogram in Early Repolarization and Acute Pericarditis

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Abstract
Electrocardiographic mimicry necessitates differentiation between acute pericarditis and early repolarization. Among 96 persons, limb-lead RS-T deviations occurred in all 48 with pericarditis, but only 27 with early repolarization. RS-T vectors ( RS-T) in pericarditis tended to be horizontal (25 patients) and left of the T vector,  T (28 patients); in early repolarization,  RS-T was vertical in 15 subjects and right of  T (20 subjects); P≤0.01. RS-T depression in Lead V1 was more common in pericarditis (14 vs. two); isoelectric RS-T in Lead V6 was more common in early repolarization (10 vs. one); P≤0.01. PR segment deviations occurred in both limb and precordial leads in pericarditis; in early repolarization they were confined to either lead group. Thus, R-ST deviations in both limb and precordial leads with horizontal  RS-T to left of  T and RS-T depression in Lead V1 favor pericarditis; vertical  RS-T and isoelectric RS-T in Lead V6 favor early repolarization. (N Engl J Med 295:523–526, 1976)