2019 Pericarditis Stent 
Dr. Smith's ECG Blog
AUGUST 6, 2024
These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. This led to immediate cath lab activation — which revealed total occlusion of a large 1st diagonal branch that was stented. == Below is the ECG of Patient #3 — recorded from a 35-year old man with sudden, new-onset CP.
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.
Dr. Smith's ECG Blog
JUNE 28, 2019
60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. Pericarditis? It was stented. A straight ST segment virtually never happens in inferior ST elevation that is NOT due to OMI (normal variant, pericarditis) 4. The patient had a p rior h istory of MI + stents.
Dr. Smith's ECG Blog
NOVEMBER 1, 2022
The 50-something patient with history of coronary stenting and slightly reduced LV ejection fraction. In the setting of prior stenting and reduced left ventricular ejection fraction, would pursue a heart team revascularization approach Syntax score 28.5, Pericarditis would be even more unlikely in someone without chest pain.
Dr. Smith's ECG Blog
JULY 19, 2019
Thrombectomy performed, then stent placed with improvement of TIMI 0 to TIMI 3 flow. This is the most important exception to the classic teaching of "diffuse STE without reciprocal depression is less likely ACS, more likely pericarditis". The cath lab was now activated. He was found to have 100% mid LAD occlusion.
Dr. Smith's ECG Blog
FEBRUARY 16, 2025
Despite apparently hearing the above history together with two diagnostic ECGs and a troponin compatible with OMI, the cardiologist thought the ECG represented pericarditis and recommended echocardiogram. The true AV groove LCx was "jailed" by the stent and appears occluded in the post PCI image. The OM is a much larger vessel.
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