Remove 2020 Remove Ischemia Remove Pericarditis
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A 29 year old male with chest pain, ST Elevation, and very elevated troponin T

Dr. Smith's ECG Blog

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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Three prehospital ECGs in patients with chest pain

Dr. Smith's ECG Blog

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.

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Does this T wave pattern mean anything?

Dr. Smith's ECG Blog

Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. In practice — It appears that electrical alternans is most often seen in association with regular SVT rhythms ( See the example in My Comment at the bottom of the page, in the September 7, 2020 post in Dr. Smith's ECG Blog ).

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

Dr. Smith's ECG Blog

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?

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

Dr. Smith's ECG Blog

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.

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A woman in her 20s with syncope

Dr. Smith's ECG Blog

The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. Less common etiologies include uremia, bacterial or tubercular pericarditis, chronic idiopathic pericarditis, hemorrhage, and other causes such as autoimmune diseases, radiation, myxedema, etc. What is ELECTRICAL ALTERNANS?

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

Dr. Smith's ECG Blog

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.