The electrocardiogram often fails to identify pericarditis after percutaneous transluminal coronary angioplasty.

Acute pericarditis was recognized in six of 1,316 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) between September, 1980 and December, 1984. "Atypical" chest pain different from the patients' usual exertional angina pectoris accompanied by a low grade fever and a pericardial friction rub on cardiac auscultation was considered diagnostic. Cardiac enzymes (CK-MB) were mildly elevated in three of six patients. None had perfusion defects on thallium-201 perfusion images. Serial ECG's showed minor ST-T abnormalities in five of six, while only one had the "classical" generalized ST elevation commonly expected with acute pericarditis. No patient had occlusion of the vessel undergoing PTCA nor compromise of any branch vessels in the region of the stenosis. All patients had significant dissection at the site of PTCA which may cause a regional, localized acute pericarditis not recognized by standard 12-lead ECG records.