2019, Pericarditis and STEMI - Cardiovascular Update

Healthy 45-year-old with chest pain: early repolarization, pericarditis or injury?

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

The computer interpretation was “ST elevation, consider early repolarization, pericarditis or injury.” The final cardiology interpretation confirmed the computer interpretation of “ST elevation, consider early repolarization, pericarditis or injury”. A healthy 45-year-old female presented with chest pain, with normal vitals.

Chest Pain

Chest Pain Pericarditis SCAD STEMI

ECG Blog #365 — A 30yo with Pericarditis.

Ken Grauer, MD

FEBRUARY 24, 2023

The patient was discharged with a diagnosis of acute pericarditis — and treated with a full course of colchicine and ibuprofen. The ultimate discharge diagnosis was acute pericarditis. ( From the information provided — I would not make the diagnosis of acute pericarditis. Figure-1: The initial ECG in today's case.

Pericarditis

Pericarditis Blog Chest Pain Coronary Angiogram

"Pericarditis" strikes again

Dr. Smith's ECG Blog

DECEMBER 13, 2019

mm has been described in normal subjects) Overall impression: In my opinion and experience, this ECG most likely represents a normal baseline ECG, but with a small chance of pericarditis instead. I texted this to Dr. Smith without any information, and this was his reply: "This could be pericarditis but probably is normal variant."

Pericarditis

Pericarditis Chest Pain Aortic Blog

What does this ECG show?

Dr. Smith's ECG Blog

AUGUST 4, 2024

Overall, this looks like one of the rare ECGs that is actually specific for pericarditis in my opinion. QOH versions 1 and 2 both say Not OMI, with high confidence, without any clinical context, despite the abnormal STE meeting STEMI criteria. Pericarditis maybe." There was no prior ECG for comparison.

Pericarditis

Pericarditis Chest Pain Blog Aortic

What would you do with acute chest pain and this ECG? You might see what the Queen thinks.

Dr. Smith's ECG Blog

JUNE 19, 2024

His EKG with worse pain now shows enough ST elevation to meet STEMI criteria. The undergraduate continues: This new EKG pattern is more suggestive of acute pericarditis. Usually with pericarditis, some degree of PR segment depression is expected. This is typical of pericarditis. This EKG seems to lack it.

Chest Pain

Chest Pain Pericarditis Pacemaker STEMI

A man in his late 30s with acute chest pain and ST elevation

Dr. Smith's ECG Blog

MAY 16, 2023

There is a reasonable chance of pericarditis in this case, or this could be a baseline." Here is the Queen of Heart's interpretation: The cath lab had been activated for concern of STEMI. Sadly, I did not receive enough information to adjudicate whether this patient has pericarditis or not. I immediately responded: "cool fake!

Chest Pain

Chest Pain Pericarditis Tachycardia STEMI

A 20-something with intermittent then acute chest pain

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.

Chest Pain

Chest Pain Pericarditis Blog Cardiomyopathy

Is there Terminal QRS Distortion?

Dr. Smith's ECG Blog

OCTOBER 17, 2022

If you were thinking that this is not anterior OMI because there is no reciprocal ST depression , it is important to remember that half of anterior STEMI do NOT have any reciprocal ST depression. Pericarditis? If you were thinking that this is pericarditis, that would be possible in the absence of any clinical information.

Pericarditis

Pericarditis Chest Pain Blog Arrhythmia

A 53 yo woman with cardiogenic shock. Believe me, this is not what you think.

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

So Shark Fin really is just a dramatic representation of STEMI, and can be in any coronary distribution. So this is STEMI, right? Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? It is often confused with a wide QRS due to conditions such as hyperkalemia. Which artery? Could this be myopericarditis?

Cardiogenic Shock

Cardiogenic Shock STEMI Pericarditis Blog

A middle aged female with "heartburn" and a "normal ECG" per the computer

Dr. Smith's ECG Blog

AUGUST 8, 2020

This ECG clearly meets STEMI criteria by the way, regardless of age or gender. Haven't you been taught that this favors pericarditis? Weren't you taught that concave morphology favors pericarditis? This is a high troponin (most STEMI are above 10 ng/mL for troponin I). There is no STE or STD in III an aVF.

Pericarditis

Pericarditis STEMI Chest Pain Arrhythmia

Viral symptoms, then acute chest pain and this ECG. What do you do?

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?

Chest Pain

Chest Pain Pericarditis Ultrasound Download

Three prehospital ECGs in patients with chest pain

Dr. Smith's ECG Blog

AUGUST 6, 2024

These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. It definitely does not fulfill STEMI criteria, and I would argue that it would not lead to cath lab activation in most centers. Usually with pericarditis and myocarditis — hyperacute T waves (HATW) are not present.

Chest Pain

Chest Pain Ischemia Pericarditis Tachycardia

Sometimes even ST Elevation meeting criteria is not enough to be convincing

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.

Chest Pain

Chest Pain Myocardial Infarction Blog Pericarditis

A man in his 40s with chest pain and syncope after cocaine use

Dr. Smith's ECG Blog

JULY 19, 2019

This morphology can be cause by or associated with cocaine: A Patient with Cocaine Chest Pain and Prehospital Computer interpretation of STEMI This is OMI of the anterior, lateral, and inferior walls until proven otherwise. But it does not meet STEMI criteria and it was not initially recognized. The cath lab was now activated.

Chest Pain

Chest Pain STEMI Aneurysm Pericarditis

Two patients with chest pain, with QRS obscured: which was STEMI positive, and which had Occlusion MI?

Dr. Smith's ECG Blog

JANUARY 17, 2024

The limb leads have been removed because there was no ST elevation in those leads, the QRS complexes have been obscured because this is irrelevant to STEMI criteria, and red lines have been added to measure ST segment elevation. But STEMI criteria ignore all this and look at ST segments in isolation.

Chest Pain

Chest Pain STEMI Myocardial Infarction Blog

Opiate overdose, without chest pain or shortness of breath. Cognitive dissonance.

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

Discharge Diagnosis was STEMI (The STE did not meet "criteria," so "OMI" would be better, but "STEMI" is far better than what this could have been called: NonSTEMI) Quotes from a note written by a really fine and knowledgable physician: "12-lead EKG was obtained initial 1 at time zero. Initial troponin came back negative."

Chest Pain

Chest Pain Coronary Artery Bypass Graft Pericarditis Blog

A Patient with Respiratory Failure and a Computer "Normal" ECG

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.

Chest Pain

Chest Pain Ischemia Aneurysm Myocardial Infarction

Healthy 45-year-old with chest pain: early repolarization, pericarditis or injury?

ECG Blog #365 — A 30yo with Pericarditis.

"Pericarditis" strikes again

What does this ECG show?

What would you do with acute chest pain and this ECG? You might see what the Queen thinks.

A man in his late 30s with acute chest pain and ST elevation

A 20-something with intermittent then acute chest pain

Is there Terminal QRS Distortion?

A 53 yo woman with cardiogenic shock. Believe me, this is not what you think.

A middle aged female with "heartburn" and a "normal ECG" per the computer

Viral symptoms, then acute chest pain and this ECG. What do you do?

Three prehospital ECGs in patients with chest pain

Sometimes even ST Elevation meeting criteria is not enough to be convincing

A man in his 40s with chest pain and syncope after cocaine use

Two patients with chest pain, with QRS obscured: which was STEMI positive, and which had Occlusion MI?

Opiate overdose, without chest pain or shortness of breath. Cognitive dissonance.

A Patient with Respiratory Failure and a Computer "Normal" ECG

Stay Connected