Shortening of the PR interval in pericarditis after coronary bypass surgery

Cover Page

Cite item

Full Text

Abstract

Background: Pericarditis, following pericardiotomy, is a well-known complication of cardiac surgery. The diagnosis of postpericardiotomy pericarditis (PP) is based on the electrocardiography (ECG) changes — the ST segment elevation in combination with a depression of the PR interval. However, in some cases, the ECG changes are difficult to distinguish from the changes associated with ST segment elevation acute coronary syndrome. In such cases, the diagnosis of pericarditis is made by excluding acute coronary syndrome, for which additional expensive diagnostic tests are performed. Aims: the purpose of the study is to identify a pattern in the change in the PR interval, which is detected in patients with acute pericarditis who underwent pericardiotomy during coronary bypass surgery. Methods: The observational study included 47 patients after coronary bypass surgery. We compared ECG of two groups of patients after coronary artery bypass grafting — 25 patients who demonstrated the ECG signs of acute pericarditis and 22 patients without those. Results: In most patients with PP after coronary bypass surgery, the characteristic ECG signs of acute pericarditis were accompanied by a transient shortening of the PR interval by 0.04 sec. Conclusion: The absence of such dynamics in patients after coronary artery bypass grafting without the ECG signs of pericarditis may indicate that a transient shortening of the PR interval may be an additional easily available ECG sign of acute PP.

About the authors

David P. Dundua

Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency

Email: david.doundoua@gmail.com
ORCID iD: 0000-0001-7345-0385

MD, PhD, Professor

Russian Federation, Moscow

Robert R. Khabazov

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: roba.khabazov@mail.ru
ORCID iD: 0000-0002-7855-6354

Student

Russian Federation, Moscow

Nataly A. Hricheva

Multifunctional medical center MEDSI

Email: hricheva@icloud.com
ORCID iD: 0000-0003-1489-9670

MD

Russian Federation, Moscow

References

  1. Imazio M, Gaita F, LeWinter M. Evaluation and treatment of pericarditis: a systematic review. JAMA. 2015;314(14):1498–506. doi: 10.1001/jama.2015.12763
  2. Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of acute and recurrent pericarditis: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(1):76–92. doi: 10.1016/j.jacc.2019.11.021
  3. Kytö V, Sipilä J, Rautava P. Clinical profile and influences on outcomes in patients hospitalized for acute pericarditis. Circulation. 2014;130(18):1601–1606. doi: 10.1161/CIRCULATIONAHA.114.010376
  4. Spodick DH. Pericardial rub. Prospective, Multiple observer investigation of pericardial friction in 100 patients. Am J Cardiol. 1975;35(3):357–362. doi: 10.1016/0002-9149(75)90027-2
  5. Chou TC. Electrocardiography in clinical practice. WB Saunders Company, Philadelphia; 1996. 729 р.
  6. Spodick DH. Differential characteristics of the electrocardiogram in early repolarization and acute pericarditis. N Engl J Med. 1976;295(10):523–526. doi: 10.1056/NEJM197609022951002
  7. Chen JC, Kaul P, Levy JH, et al. Myocardial infarction following coronary artery bypass graft surgery increases healthcare resource utilization. Crit Care Med. 2007;35(5):1296–1301. doi: 10.1097/01.CCM.0000262403.08546.A2
  8. Nalysnik L, Fahrbach K, Reyniolds MW, et al. Adverse events in coronary artery bypass graft (CABG) trials: a systematic review and analysis. Heart. 2003;89(7):767–772. doi: 10.1136/heart.89.7.767
  9. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography) Circulation. 2003;108(9):1146–1162. doi: 10.1161/01.CIR.0000073597.57414.A9
  10. Permanyer-Miralda G, Sagristá-Sauleda J, Soler-Soler J. Primary acute pericadial disease: a prospective series of 231 consecutive patients. Am J Cardiol. 1985;56(10):623–630. doi: 10.1016/0002-9149(85)91023-9
  11. Imazio M, Demichelis B, Cecchi E, et al. Cardiac troponin I in acute pericarditis. J Am Coll Cardiol. 2003;42(12):2144–2148. doi: 10.1016/j.jacc.2003.02.001

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Typical electrocardiogram in acute coronary syndrome with ST segment elevation (а) and acute pericarditis (б): а — for acute coronary syndrome, the curved, monophasic elevation of the ST segment, the PR interval on the isoline is more characteristic; б — in acute pericarditis, the elevation of the ST segment has a saddle-shaped shape, its degree is less pronounced, while depression of the PR interval is noted.

Download (840KB)
Indexing metadata
3. Fig. 2. Electrocardiogram of the patient: а — on the day of coronary bypass surgery: ST and PR segments on the isoline; the duration of the PR interval is 0.134 seconds; б — on the 2nd day after surgery: in addition to the elevations of the ST segment in leads V2–V3, attention is drawn to the shortening of the PR interval to 0.116 seconds, which does not allow to assess its position relative to the isoline.

Download (1MB)
Indexing metadata

Copyright (c) 2022 Dundua D.P., Khabazov R.R., Hricheva N.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies