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In pericarditis, the hallmark finding on a 12-lead ECG is concave ST segment elevation across multiple leads. This characteristic ST elevation typically presents in a widespread pattern, often seen in the precordial leads (V1 to V6) and can extend into the limb leads. This concave appearance is crucial for differentiating pericarditis from other conditions that may present with ST elevation, such as myocardial infarction, which usually exhibits a different pattern (often convex or more localized ST elevations).

Additionally, as the condition progresses, it is not uncommon to see normalization of these changes or even the appearance of T-wave inversions. The presence of ST segment elevation in pericarditis is often accompanied by other ECG changes such as PR segment depression, which further supports the diagnosis.

This understanding clarifies the distinctive ECG findings associated with pericarditis, emphasizing the importance of recognizing the pattern of concave ST elevations when diagnosing this condition.