Dr. Smith's ECG Blog

MAY 16, 2023

There is a reasonable chance of pericarditis in this case, or this could be a baseline." Sadly, I did not receive enough information to adjudicate whether this patient has pericarditis or not. I sent this to Dr. Smith and this was his response: "Likely pericarditis, but that is perilous. I immediately responded: "cool fake!

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Dr. Smith's ECG Blog

APRIL 9, 2024

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?

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Dr. Smith's ECG Blog

APRIL 25, 2023

First, many on Twitter said "Pericarditis". This is NOT pericarditis, which virtually NEVER has ST depression any where except aVR. See our publication: ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis There is STE in inferior leads, high lateral leads, and V4-V6.

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Dr. Smith's ECG Blog

OCTOBER 17, 2022

Pericarditis? If you were thinking that this is pericarditis, that would be possible in the absence of any clinical information. However, there is zero PR depression which would be VERY unusual in pericarditis. P.S.: Acute pericarditis may produce diffuse ST elevation. Presence of STD is helpful; absence is not.

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Dr. Smith's ECG Blog

JANUARY 10, 2020

It could also be due to pericarditis or myocarditis, but I always say that "you diagnose pericarditis at your peril." The clinical presentation is very suggestive of myo-pericarditis. But one should always remember that acute MI is a far more common pathology than myo- or pericarditis. Pericarditis?

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Dr. Smith's ECG Blog

AUGUST 8, 2020

Haven't you been taught that this favors pericarditis? Weren't you taught that concave morphology favors pericarditis? Expert ECG interpretation can often distinguish normal variant STE from OMI from pericarditis. Smith = “You diagnose acute pericarditis at your peril”. We will study this soon with our database.

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Dr. Smith's ECG Blog

AUGUST 6, 2024

These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. Usually with pericarditis and myocarditis — hyperacute T waves (HATW) are not present. S mith : there is STE in lead III and reciprocal STD in aVL. This is OMI until proven otherwise.

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Dr. Smith's ECG Blog

DECEMBER 10, 2019

Echo does not necessarily differentiate acute MI from pericarditis: both may have wall motion abnormalities. This is why I frequently write: "You diagnose pericarditis at your peril." I have therefore found this sign of limited usefulness in most instances when contemplating a diagnosis of acute pericarditis or myocarditis.

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Dr. Smith's ECG Blog

FEBRUARY 16, 2020

Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? But it is very distinct from hyperkalemia (and anything else, including VT), and such confusion can only be due to lack of familiarity, because, if you look closely, its morpholgoy is very different from anything else. So this is STEMI, right? Which artery?

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Dr. Smith's ECG Blog

NOVEMBER 14, 2019

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.

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Dr. Paddy Barrett

APRIL 5, 2024

Traditionally used as an anti-inflammatory for pericarditis (inflammation of the lining of the heart), it has recently been shown to result in fewer major heart events in those with a recent heart attack. 2019 Dec 26;381(26):2497-2505. It is an easy win, frequently missed. 2021 May 1;397(10285):1625-1636. N Engl J Med.

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Dr. Smith's ECG Blog

NOVEMBER 13, 2022

This is a bad ST vector orientation, because it causes widespread STE and one of the most important mistakes that needs to be avoided here is thinking of the diagnosis of pericarditis. Such an out-of-proportion STE is virtually never seen in pericarditis. 2019 Apr;21(5):253-258. Look at the STE in lead II, aVF. Anatol J Cardiol.

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Dr. Smith's ECG Blog

JANUARY 15, 2024

The "flu-like" illness suggests myo- or pericarditis, but that would be a diagnosis of exclusion. The September 27, 2019 post — for the Rowlands & Moore article with the above-noted formulas for recognizing the “culprit” extremity. The September 22, 2019 post — intermittent ST-T wave artifact. The case continues.

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Dr. Smith's ECG Blog

NOVEMBER 1, 2022

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. Initial troponin came back negative." Sodium channel blockade effect from unidentified drug?" "In

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Dr. Smith's ECG Blog

JUNE 28, 2019

Pericarditis? A straight ST segment virtually never happens in inferior ST elevation that is NOT due to OMI (normal variant, pericarditis) 4. 60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. Time zero What do you think? There is inferior ST elevation. Is it normal variant?

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Dr. Smith's ECG Blog

NOVEMBER 25, 2022

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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Dr. Smith's ECG Blog

JULY 21, 2019

There is also mild pericardial enhancement consistent with pericarditis. He later underwent an MRI: 1) Mildly decreased LV function with no focal wall motion abnormalities 2) Patchy intramyocardial delayed enhancement compatible with myocarditis. Overall findings are consistent with myopericarditis.

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Dr. Smith's ECG Blog

JULY 19, 2019

This is the most important exception to the classic teaching of "diffuse STE without reciprocal depression is less likely ACS, more likely pericarditis".

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Dr. Smith's ECG Blog

MARCH 11, 2019

You do NOT see this in normal variant STE, nor in pericarditis. Here is the computer interpretation: (Veritas algorithm) This is what I said: "This is diagnostic of an acute inferior MI. There is upsloping ST elevation in III, with reciprocal ST depression in aVL.

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Dr. Smith's ECG Blog

JANUARY 17, 2024

The initial computer and final cardiology interpretation was a differential: “ST elevation, consider early repolarization, pericarditis, or injury.” But STEMI criteria ignore all this and look at ST segments in isolation. Based on STEMI criteria and unhelpful computer interpretation, the patient was rushed to the cath lab.

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