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Overall, this looks like one of the rare ECGs that is actually specific for pericarditis in my opinion. Pericarditis maybe." Meyers' words — "is one of the rare ECGs that is actually specific for pericarditis". ii ) Today's case emphasizes the importance of the history in making the diagnosis of pericarditis.
It is easy to say pericarditis in such a case. young male no risk factors and ST-elevation in several leads) As Dr. Smith has emphasized many times you diagnose pericarditis at your patient's and your own peril. Version 1 was not trained to detect myo- or pericarditis. The above ECG was recorded. How did the Queen do?
In any case, the ECG is diagnostic of severe ischemia and probably OMI. These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. Nossen Comment/Interpretation: Evaluation of ischemia on an ECG can be very challenging. Concordant STE of 1 mm in just one lead or 2a.
Echo does not necessarily differentiate acute MI from pericarditis: both may have wall motion abnormalities. The septum appears a bit darker than the rest, and you might be fooled into thinking there is ongoing ischemia here. See an examples of CT ischemia here. There was a CT chest image from the previous day.
Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? Our chief of cardiology, Gautam Shroff, interprets it differently and thinks this is indeed ischemia. So this is STEMI, right? Which artery? There is ST Elevation in every lead except aVR (STD in aVR). Could this be myopericarditis?
Haven't you been taught that this favors pericarditis? Weren't you taught that concave morphology favors pericarditis? Weren't you taught that "new tall T wave in V1" is concerning for ischemia, and so this is the opposite? Expert ECG interpretation can often distinguish normal variant STE from OMI from pericarditis.
You do NOT see this in normal variant STE, nor in pericarditis. The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW." Here is the patient's troponin I profile: These were interpreted as due to demand ischemia, or type II MI.
2 days later This is a typical LVH pattern, without ischemia Patient underwent 4 vessel CABG. Assessment:" " Nonspecific ST elevation from V1-V4 , question of early repolarization versus pericarditis , question of acute current of injury and ? Pericarditis would be even more unlikely in someone without chest pain.
Pericarditis? For coronary anatomy, see here: [link] This is the post intervention ECG: All ST Elevation is gone (more proof that it was all a result of ischemia) Formal Echo: Normal estimated left ventricular ejection fraction - 55%. More likely, these T waves probably reflect ischemia of uncertain age. Is it normal variant?
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?
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