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? 13, 2019 Dr.

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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

NOVEMBER 29, 2023

Of course the patient was saddled with the erroneous "pericarditis" diagnosis after CTs ruled also ruled out PE and dissection. Serial ECGs remained unchanged. Echo showed normal EF and no wall motion abnormalities, and no pericardial effusion. But he did well. 25 minutes later, EMS called back with this new ECG: Super obvious STEMI(+) OMI.

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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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Ken Grauer, MD

SEPTEMBER 21, 2024

Pericarditis is rare — but myocarditis is not , so especially in this age group — more information is needed to quickly determine if this could be an acute MI, myocarditis, or none of the above. That said — acute MI does occur in younger patients.

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Dr. Smith's ECG Blog

DECEMBER 11, 2023

Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." St depression in lead AVL differentiates inferior st-elevation myocardial infarction from pericarditis. link] Bischof, J. Worrall, C.,

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Dr. Smith's ECG Blog

OCTOBER 23, 2023

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 ). Seeing it in this context suggests ( but does not prove ) the existence of an AP ( A ccessory P athway ).

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Dr. Anish Koka

JUNE 5, 2023

The KDCA also established a reporting system with a legal obligation for special adverse events including myocarditis and pericarditis after COVID-19 vaccination. Perhaps you decide vaccination is the right thing for you or your 13 year old after weighing the pros and cons.

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All About Cardiovascular System and Disorders

OCTOBER 26, 2023

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. 2020 Sep;31(9):2474-2483. J Cardiovasc Electrophysiol. Gourraud JB, Barc J, Thollet A, Le Marec H, Probst V.

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Dr. Smith's ECG Blog

OCTOBER 11, 2020

As always, takotsubo cardiomyopathy and focal pericarditis can mimic OMI, but takotsubo almost never mimics posterior MI, and both are diagnoses of exclusion after a negative cath. And a complication. == MY Comment by K EN G RAUER, MD ( 10/11/2020 ): == It cannot be stated any clearer than what Dr. Meyers states above. Is that normal?

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Dr. Smith's ECG Blog

NOVEMBER 28, 2022

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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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 November 10, 2020 post — for PTA. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ". Do not wait for the troponin; a lot of myocardium will be dead if you do. 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

JANUARY 9, 2023

Pericarditis? There is a literature on this subject ( GGF van der Schoot et al: Neth Heart J 28(6):301-308, 2020 — and — Egred et al — Postgrad Med 81(962): 741-745, 2005 — to name just 2 reports ). Chest Pain in a Male in his 20's; Inferior ST elevation: Inferior lead "early repol" diagnosed. Beware a negative Bedside ultrasound.

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Dr. Smith's ECG Blog

JANUARY 12, 2023

False Positive ST elevation in aVL Even when the story is obvious, with intractable pain, the STEMI paradigm can cause preventable delays Man in his 60's with very subtle ECG and pain not controlled with medical therapy Pericarditis vs. MI #2 See other "Quiz Posts": Quiz post - which of these, if any, are OMI? Will you activate the cath lab?

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Dr. Anish Koka

JANUARY 1, 2023

The case reports Case 1 involves a 26 year old man who developed pericarditis after the Pfizer vaccine. Pericarditis, an inflammation of the sac the heart lives in, developed about 7 days after the Pfizer vaccine. The diagnosis was made based on classic findings of inflammation on an electrocardiogram associated with acute chest pain.

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Dr. Anish Koka

FEBRUARY 20, 2023

It is relevant to note here that as a physician active clinically in both the inpatient and outpatient arenas, I am an eyewitness to the severe toll COVID19 took on my patients in the Spring or 2020. He has had COVID twice, first in September of 2020, and his second time in January of 2023. The pain resolved a few weeks later.

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Dr. Smith's ECG Blog

DECEMBER 5, 2023

Though less prevalent in younger patients, occlusion MI may occur and requires the same early interventions as older patients. - - Pericarditis and myocarditis should be a diagnosis of exclusion. I've listed potential causes of acute pericarditis in My Comment at the bottom of the page in the June 11, 2022 post in Dr. Smith's ECG Blog.

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Dr. Smith's ECG Blog

JANUARY 21, 2023

Internat J Arrhyth 2020 Uesako H, Fukikawa H, Hashimoto S, et al. Prominent J waves and ventricular fibrillation caused by myocarditis and pericarditis after BNT162b2 mRNA COVID-19 vaccination. The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy.

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Dr. Smith's ECG Blog

FEBRUARY 26, 2025

The exception is with postinfarction pericarditis , in which a completed transmural infarct results in inflammation of the subepicardial myocardium and STE in the distribution of the infarct, and which results in increased STE and large upright T-waves. These findings together are more commonly seen with pericarditis.

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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 emergency physician consulted cardiology. Several hours passed with no documentation as to the reason for delay.

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Heart BMJ

NOVEMBER 19, 2024

The ‘prevaccination’ cohort comprised unvaccinated patients with CHD and matched controls with first-recorded SARS-CoV-2 infection between 1 March and 8 December 2020 (7805 cases, 27 620 controls). Compared with vaccinated controls, vaccinated patients with CHD remained at increased risk of hospitalisation (0.5%

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