PMID- 32222321
OWN - NLM
STAT- MEDLINE
DCOM- 20210623
LR  - 20210623
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 58
IP  - 4
DP  - 2020 Apr
TI  - Evaluation of Spodick's Sign and Other Electrocardiographic Findings as 
      Indicators of STEMI and Pericarditis.
PG  - 562-569
LID - S0736-4679(20)30020-2 [pii]
LID - 10.1016/j.jemermed.2020.01.017 [doi]
AB  - BACKGROUND: Patients with ST elevation on electrocardiogram (ECG) could have ST 
      elevation myocardial infarction (STEMI) or pericarditis. Spodick's sign, a 
      downsloping of the ECG baseline (the T-P segment), has been described, but not 
      validated, as a sign of pericarditis. OBJECTIVE: This study estimates the 
      frequency of Spodick's sign and other findings in patients diagnosed with STEMI 
      and those with pericarditis. METHODS: In this retrospective review, we selected 
      charts that met prospective definitions of STEMI (cases) and pericarditis 
      (controls). We excluded patients whose ECGs lacked ST elevation. An authority on 
      electrocardiography reviewed all ECGs, noting the presence or absence of 
      Spodick's sign, ST depression (in leads besides V(1) and aVR), PR depression, 
      greater ST elevation in lead III than in lead II (III > II), abrupt take-off of 
      ST segment (the RT checkmark sign), and upward or horizontal ST convexity. We 
      quantified strength of association using odds ratio (OR) with 95% confidence 
      interval (CI). RESULTS: One hundred and sixty-five patients met criteria for 
      STEMI and 42 met those for pericarditis. Spodick's sign occurred in 5% of 
      patients with STEMI (95% CI 3-10%) and 29% of patients with pericarditis (95% CI 
      16-45%). All other findings statistically distinguished STEMI from pericarditis, 
      but ST depression (OR 31), III > II (OR 21), and absence of PR depression (OR 12) 
      had the greatest OR values. CONCLUSIONS: Spodick's sign is statistically 
      associated with pericarditis, but it is seen in 5% of patients with STEMI. Among 
      other findings, ST depression, III > II, and absence of PR depression were the 
      most discriminating.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Witting, Michael D
AU  - Witting MD
AD  - Department of Emergency Medicine, University of Maryland School of Medicine, 
      Baltimore, Maryland.
FAU - Hu, Kami M
AU  - Hu KM
AD  - Department of Emergency Medicine, University of Maryland School of Medicine, 
      Baltimore, Maryland.
FAU - Westreich, Aaron A
AU  - Westreich AA
AD  - University of Minnesota Masonic Children's Center, Minneapolis, Minnesota.
FAU - Tewelde, Semhar
AU  - Tewelde S
AD  - Department of Emergency Medicine, University of Maryland School of Medicine, 
      Baltimore, Maryland.
FAU - Farzad, Ali
AU  - Farzad A
AD  - Department of Emergency Medicine, Baylor University Medical Center, Dallas, 
      Texas; Texas A&M College of Medicine, College Station, Texas.
FAU - Mattu, Amal
AU  - Mattu A
AD  - Department of Emergency Medicine, University of Maryland School of Medicine, 
      Baltimore, Maryland.
LA  - eng
PT  - Journal Article
DEP - 20200325
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
SB  - IM
MH  - Electrocardiography
MH  - Humans
MH  - *Pericarditis/diagnosis
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - *ST Elevation Myocardial Infarction/diagnosis
OTO - NOTNLM
OT  - ST elevation myocardial infarction
OT  - chest pain
OT  - electrocardiography
OT  - emergency service
OT  - hospital
OT  - pericarditis
EDAT- 2020/03/31 06:00
MHDA- 2021/06/24 06:00
CRDT- 2020/03/31 06:00
PHST- 2019/08/17 00:00 [received]
PHST- 2020/01/06 00:00 [revised]
PHST- 2020/01/20 00:00 [accepted]
PHST- 2020/03/31 06:00 [pubmed]
PHST- 2021/06/24 06:00 [medline]
PHST- 2020/03/31 06:00 [entrez]
AID - S0736-4679(20)30020-2 [pii]
AID - 10.1016/j.jemermed.2020.01.017 [doi]
PST - ppublish
SO  - J Emerg Med. 2020 Apr;58(4):562-569. doi: 10.1016/j.jemermed.2020.01.017. Epub 
      2020 Mar 25.