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?

Chest Pain 108

Chest Pain Pericarditis Blog Tachycardia 108

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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Chest Pain Pericarditis Tachycardia STEMI 52

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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Myocardial Infarction Chest Pain STEMI Blood Pressure 123

DAIC

MARCH 28, 2024

In Europe, the TRUPULSE generator received CE mark in late 2023 and the VARIPULSE Catheter received CE mark in February 2024. In the U.S., the VARIPULSE Catheter and TRUPULSE Generator are currently investigational and are not approved by FDA. For more information: www.biosensewebster.com References: i. doi: 10.1016/j.jacc.2014.04.072

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Atrial Fibrillation AFIB Ablation Pulmonary 110

ECG Weekly Workout

NOVEMBER 26, 2023

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Chest Pain 40

Chest Pain Pericarditis 40

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. Acute coronary occlusion almost always occurs in patients who are beyond their 20s. That said — acute MI does occur in younger patients.

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Chest Pain Blog Thrombosis Tachycardia 120

Circulation: Cardiovascular Imaging

NOVEMBER 20, 2023

Circulation: Cardiovascular Imaging, Volume 16, Issue 11 , Page e015606, November 1, 2023. BACKGROUND:Pericardial late gadolinium enhancement (LGE) is usually associated with active pericarditis, but it is not infrequently found in patients after cardiac surgery even a long time after the intervention.

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Pericarditis Cardiovascular Imaging Circulation 40

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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Chest Pain Ischemia Pericarditis Tachycardia 104

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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Chest Pain Pericarditis Blog Cardiomyopathy 52

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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STEMI Chest Pain Blog Pericarditis 125

Dr. Smith's ECG Blog

JUNE 17, 2024

Dyspnea, Chest pain, Tachypneic, Ill appearing: Bedside Cardiac Echo gives the Diagnosis 31 Year Old Male with RUQ Pain and a History of Pericarditis. I refer to My Comment in the March 4, 2023 post — in which I included a Table with ECG Findings of Acute PE. Submitted by a Med Student, with Great Commentary on Bias!

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Chest Pain Embolism Pulmonary Tachycardia 138

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. 2023 Nov 11. It is an easy win, frequently missed. Br J Gen Pract. 2018 Mar;68(668):151-152. N Engl J Med.

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Heart Disease Coronary Artery Disease Heart attacks Heart Attack 118

Dr. Smith's ECG Blog

OCTOBER 23, 2023

PMID: 11723026. == MY Comment , by K EN G RAUER, MD ( 10/23 /2023 ): == The various forms of electrical alternans are frequently misunderstood, if not completely unnoticed. Chronic amiodarone evokes no torsade de pointes arrhythmias despite QT lengthening in an animal model of acquired long-QT syndrome. Circulation.

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Tachycardia Cardiac Arrest ICU Blog 130

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Bottom Line: Tests other than cardiac cath may be all that are needed to establish the diagnosis — but, I'd want to see a patient with this ECG as soon as would be possible.

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Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 122

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

Brugada Syndrome: Diagnosis and Risk Stratification Hello friends, this is the modified version of my talk at Indian Heart Rhythm Society Conference, New Delhi, 2023, on Brugada Syndrome. Hope you will enjoy this session. These are the conditions which have to be considered or excluded as they can sometimes manifest Brugada pattern on ECG.

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Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

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. The 2023 risk/benefit calculus casts a very long shadow on those who seek to compel their fellow citizens to vaccinate.

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COVID-19 Sudden Cardiac Death Public Health Pericarditis 52

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 15, 2023 post — for PTA ( Pulse-Tap Artifact ). The April 6, 2023 post — excessive baseline artifact misdiagnosed as AFib ( instead of sinus rhythm with AV Wenckebach — as in Figure-4 in this post ).

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Chest Pain Blog Arrhythmia Critical Care 64

Ken Grauer, MD

APRIL 23, 2023

To Emphasize: When the patient is older and presents with a history of cardiac-sounding chest pain — then acute infarction will be much more common than acute pericarditis, myocarditis, or perimyocarditis. A DDENDUM ( 4/24/2023 ) : One of the most problematic areas in arrhythmia interpretation is assessment of the AV Blocks.

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Blog Chest Pain Arrhythmia Download 78

Dr. Smith's ECG Blog

JANUARY 9, 2023

Pericarditis? My Comment by K EN G RAUER, MD ( 1/9 /2023 ): = “ Treat the patient — Not the age of the patient”. They still would not do angiography for her: See other cases of young patients with OMI: A 16 year old girl has syncope while playing basketball. 24 yo woman with chest pain: Is this STEMI?

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Chest Pain Aneurysm STEMI Thrombosis 52

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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Chest Pain STEMI Blog Stenosis 52

Dr. Anish Koka

FEBRUARY 20, 2023

In August, the CDC reported 29 cases of pericarditis, including five in persons with a history of pericarditis after mRNA COVID-19 vaccine ; 10 Importantly, the Novovax vaccine is a protein based vaccine that was hoped to not be associated with myocarditis as was noted with the mRNA vaccines. The pain resolved a few weeks later.

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COVID-19 Pericarditis Chest Pain Public Health 52

Dr. Smith's ECG Blog

MAY 23, 2022

First Troponin I was <2 and peak was 8, echo showed subtle apical lateral hypokinesis, CRP was elevated, and patient was discharged with a diagnosis of regional pericarditis. In this case, there would be evolution, but the evolution would be typical of pericarditis (if the diagnosis of pericarditis was accurate!!

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Chest Pain Pericarditis STEMI Arrhythmia 52

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.” Acad Emerg Med 2023 3. Ann Emerg Med 2023 4. But STEMI criteria ignore all this and look at ST segments in isolation. Smith, Meyers. Meyers, Bracey et al.

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Chest Pain STEMI Myocardial Infarction Blog 118

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. PMID: 34013488; PMCID: PMC8134825. == MY Comment , by K EN G RAUER, MD ( 12/5 /2023 ): == Interesting case by Drs. World J Pediatr.

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Pediatrics Pericarditis COVID-19 Congenital Heart Disease 120

Dr. Smith's ECG Blog

JANUARY 21, 2023

Prominent J waves and ventricular fibrillation caused by myocarditis and pericarditis after BNT162b2 mRNA COVID-19 vaccination. 2004 = My Comment by K EN G RAUER, MD ( 1/21 /2023 ): = I thought today's case by Drs. The relationship between J wave and ventricular tachycardia during Takotsubo cardiomyopathy.

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STEMI Bradycardia Arrhythmia Cardiac Arrest 52

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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STEMI Pericarditis Chest Pain Echocardiogram 72

Dr. Smith's ECG Blog

JANUARY 9, 2025

Although this is not a common phenomenon You will see it on occasion ( See the June 30, 2023 post the November 27, 2023 post and the July 24, 2013 post in Dr. Smith's ECG Blog ). Smith : I recognize this as a STEMI mimic. I was not alarmed. The providers showed me the ECG and I told them that I thought it was a fake.

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Chest Pain Ischemia Dysrhythmia Arrhythmia 106