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It is not always possible to be certain about the origin of chestpain just by its characteristics as the variation between individuals is quite a bit. A medical opinion should be sought in case of any significant chestpain so that important ailment is not missed. A pain lasting more than 30 minutes is usual.
This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). As already mentioned, this patient could have post-infarction regional pericarditis from a large completed MI. Sinus tachycardia has many potential causes. Hammill SC.
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chestpain similar to his prior MI, but worse. The pain initially started the day prior to presentation. The ST elevation from today is ~0.2
Pericarditis refers to inflammation of the pericardium The pericardium is a sac within which the heart sits. Acute inflammation of this sac is known as acute pericarditis. About 5% of patients who present to A+E with chestpain which is not deemed to be a heart attack or angina are ultimately diagnosed with pericarditis.
3 hours prior to calling 911 he developed typical chestpain. This rules out pericarditis, which essentially never has reciprocal ST depression. This is not pericarditis because: a. Pain was typical for MI (substernal, not postional or sharp, resolved with NTG) b. Pericarditis does not have reciprocal depression.
They were recorded 12 minutes apart: "Hey Steve, 30-something with one week of chestpain, mostly right-sided, better with sitting up.": I learned more about the history: 30-something African American with 5-7days of sharp R-sided shoulder/scapula/chest discomfort, presented with sinus tachycardia. What do you think?
A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chestpain for 1.5 More likely, the patient had crescendo angina, with REVERSIBLE ischemia for 48 hours that only became potentially irreversible (STEMI) at that point in time. Myocardial Rupture and Postinfarction Pericarditis.
A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chestpain, dyspnea and weakness on the treadmill. In the ED he had some continued chestpain and hypotension. Myocardial rupture is usually preceded by postinfarction regional pericarditis (PIRP).
Scenario 1 : The patient presents with 24 hours of substernal chestpain. 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.
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