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Inflammatory pericarditis can occur in differential fashion. For example, the most common chronic pericarditis tuberculosis affects the fibrinous layer. Post MI pericarditis involves the epicardium. Diastolic Coronary Artery Compression in Constrictive Pericarditis. Angina caused by calcific constrictive pericarditis.
ST depression in lead AVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Am J Emerg Med 2016 5. Kontos et al. J Am Coll Cardiol 2022 4. Bischof et al. Meyers et al.
ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. 2016, April 13). Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated. ST depression. Zangouri, V.,
Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." St depression in lead AVL differentiates inferior st-elevation myocardial infarction from pericarditis. Circulation , 130 (25).
T-wave to ST ratio is greater than 4 in lead V6, making pericarditis unlikely (also there were no symptoms of pericarditis). N Engl J Med 2008;358(19):2016-23. There is ST elevation diffusely: 2 mm in V2, 3.5 mm in V3, 2.5 mm in V4, 1.5 mm in V5, and 1 mm in V6, 1.5 mm in lead II, 1 mm in leads III and aVF.
Fortunately, there was an ECG from about a year prior: And here is one from about 10 years prior: You can see here that the computer says "suggests pericarditis" but that I changed it to early repolarization. Just because there is diffuse ST elevation does NOT mean it is pericarditis.
They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. Shanghai Score was arrived at in a consensus conference held in 2016. 2016 Oct;13(10):e295-324.
ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. ST depression. Myocardial Contusion?
First Troponin I was <2 and peak was 8, echo showed subtle apical lateral hypokinesis, CRP was elevated, and patient was discharged with a diagnosis of regional pericarditis. In this case, there would be evolution, but the evolution would be typical of pericarditis (if the diagnosis of pericarditis was accurate!!
Though less prevalent in younger patients, occlusion MI may occur and requires the same early interventions as older patients. - - Pericarditis and myocarditis should be a diagnosis of exclusion. 2016 Apr 12;67(14):1738-49. Circulation. 2021 Aug 10;144(6):e123-e135. doi: 10.1161/CIR.0000000000001001. 0000000000001001. Epub 2021 Jul 7.
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