Spotting Spodick Sign in the Diagnostic Dilemma—Reply

In Reply We would like to express our gratitude to Dr Wu and colleagues for recognizing Spodick sign on the results of a postpercutaneous coronary intervention (PCI) electrocardiogram (ECG) in our case report.1 Spodick sign is characterized as a downsloping TP segment that is most clearly identified in lead II and the lateral precordial leads. Although Spodick sign can distinguish pericarditis from ST elevation myocardial infarction (STEMI), it should be noted that there are no absolute pathognomonic signs to differentiate STEMI or pericarditis. One sign might be found concurrent to another disorder, albeit with a lower probability.2 Makaryus and colleagues3 and Chaubey and Chhabra4 reported that Spodick sign was found in 80% of cases of pericarditis, but the latest report by Witting and colleagues2 showed that the frequency of Spodick sign was 29% in pericarditis and 5% in STEMI. These authors also reported that the median number of leads showing downsloping TP segment was 4 (range, 1-6) in patients with pericarditis and 3 (range, 1-6) in patients with STEMI.2 Furthermore, Spodick sign criteria are only met when more than 1 lead shows the downsloping of the TP segment.