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Cardiology

PR Segment—A Neglected Electrocardiogram Profile in Acute Chest Pain

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JAMA Internal Medicine

Published Online: October 3, 2022

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Shiwang Wang, MD¹;

Yangyi Lin, MD²

Author Affiliations

¹Department of Cardiology, Hangzhou Dingqiao Hospital, Zhejiang Province, China
²Department of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

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A patient in their 40s with no medical history presented to the emergency department with chest pain of a 4-hour duration. The pain was substernal, intensified by lying supine, and relieved by leaning forward. On admission, the patient’s vital signs included a temperature of 37.3 °C, blood pressure of 147/93 mm Hg, pulse rate of 103 beats/min, and respiratory rate of 20 breaths/min. The results of the rest of the physical examination were normal. The troponin I and N-terminal pro–brain natriuretic peptide levels were normal. A transthoracic echocardiogram demonstrated normal ventricular ejection fraction, chamber size, and motion and the absence of pericardial effusion. The 12-lead electrocardiogram (ECG) at admission is shown in the Figure, A.

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A patient in their 40s with no medical history presented to the emergency department with chest pain of a 4-hour duration. The pain was substernal, intensified by lying supine, and relieved by leaning forward. On admission, the patient’s vital signs included a temperature of 37.3 °C, blood pressure of 147/93 mm Hg, pulse rate of 103 beats/min, and respiratory rate of 20 breaths/min. The results of the rest of the physical examination were normal. The troponin I and N-terminal pro–brain natriuretic peptide levels were normal. A transthoracic echocardiogram demonstrated normal ventricular ejection fraction, chamber size, and motion and the absence of pericardial effusion. The 12-lead electrocardiogram (ECG) at admission is shown in the Figure, A.

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Article Information

Corresponding Author: Yangyi Lin, MD, Department of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, China (dr.linyangyi@outlook.com).

Published Online: October 3, 2022. doi:10.1001/jamainternmed.2022.4037

Conflict of Interest Disclosures: None reported.

References

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Ariyarajah V , Spodick DH . Acute pericarditis: diagnostic cues and common electrocardiographic manifestations. Cardiol Rev. 2007;15(1):24-30. doi:10.1097/01.crd.0000210645.89717.34 PubMed Google Scholar Crossref

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Patton KK , Ellinor PT , Ezekowitz M , et al; American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology and Council on Functional Genomics and Translational Biology. Electrocardiographic early repolarization: a scientific statement from the American Heart Association. Circulation. 2016;133(15):1520-1529. doi:10.1161/CIR.0000000000000388 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.