Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

The computer interpretation was “ST elevation, consider early repolarization, pericarditis or injury.” The final cardiology interpretation confirmed the computer interpretation of “ST elevation, consider early repolarization, pericarditis or injury”. A healthy 45-year-old female presented with chest pain, with normal vitals.

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Dr. Smith's ECG Blog

JUNE 20, 2018

Clinician and EKG machine read of acute pericarditis. While it is true that inferior MI has ST depression in aVL 99% of the time (Bischof and Smith), and that inferolateral ST elevation is the most common distribution for pericarditis, the ST elevation in V3 has "terminal QRS distortion (TQRSD)," (diagnostic of LAD occlusion).

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Ken Grauer, MD

APRIL 23, 2023

Assessing the Rhythm: I favor use of the P s , Q s , 3 R Approach for assessing the cardiac rhythm ( See ECG Blog #185 ). As emphasized in ECG Blog #326 ( and as I review in the ADDENDUM below ) — Mobitz I, 2nd-Degree AV Block ( ie, AV Wenckebach ) — is by far (!) ECG Blog #236 — Reviews the 3 Types of 2nd-Degree AV Block.

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Dr. Smith's ECG Blog

DECEMBER 20, 2013

Here is his initial ED ECG: The R-wave in V4 extends to 33 mm, the computerized QTc is 372 ms The only available previous ECG is from one year ago, during the admission when he was diagnosed with pericarditis: 1 year ago ECG, with clinician and computer interpretatioin of pericarditis Normal 0 false false false EN-US X-NONE X-NONE What do you think?

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Dr. Smith's ECG Blog

AUGUST 24, 2012

But there was some doubt as to whether it might be pericarditis because of the ST elevation in I and II, without ST depression in III. Add that to "sharp" pain and a 33 year old, and it is easy to convince yourself that this is, indeed, pericarditis. This is a good sign for myocardial infarction and does not happen in pericarditis.

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Dr. Sanjay Gupta

DECEMBER 19, 2022

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 chest pain which is not deemed to be a heart attack or angina are ultimately diagnosed with pericarditis.

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Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

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.

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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. Keep an eye on the blog as an OMI QUIZ soon will be published where you test yourself vs the Queen!

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Dr. Smith's ECG Blog

JUNE 19, 2024

The undergraduate continues: This new EKG pattern is more suggestive of acute pericarditis. Usually with pericarditis, some degree of PR segment depression is expected. This is typical of pericarditis. But, as I always say, you diagnose pericarditis at your peril. This EKG seems to lack it.

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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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Dr. Smith's ECG Blog

OCTOBER 17, 2022

Pericarditis? If you were thinking that this is pericarditis, that would be possible in the absence of any clinical information. However, there is zero PR depression which would be VERY unusual in pericarditis. P.S.: Acute pericarditis may produce diffuse ST elevation. Presence of STD is helpful; absence is not.

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Dr. Smith's ECG Blog

MAY 29, 2024

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. 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

OCTOBER 23, 2023

In our hope of increasing appreciation of the clinical insights that this fascinating phenomenon may provide — we highlight its occurrence in our blog posts. I last reviewed the phenomenon of electrical alternans in My Comment at the bottom of the page in the November 28, 2022 post of Dr. Smith's ECG Blog.

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Dr. Smith's ECG Blog

JUNE 17, 2018

PR depression, which suggests pericarditis 4. We also showed that, of 47 cases of pericarditis with ST elevation, none had ST depression in aVL. ) I’ll add the following 2 comments: i ) This patient presumably has effusive-constrictive pericarditis. Absence of any ST depression in aVL. ( Clin Cardiol 22:334-344, 1999 ).

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Dr. Smith's ECG Blog

JUNE 18, 2011

This rules out pericarditis, which essentially never has reciprocal ST depression. This is not pericarditis because: a. Pericarditis does not have reciprocal depression. ST elevation of pericarditis is maximal in leads II and V5, V6. Pericarditis does not have hyperacute T-waves.

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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. The October 15, 2022 post in Dr. Smith's ECG Blog features no less than 20 ECG examples by Drs. Serial ECGs remained unchanged. But he did well.

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STEMI Chest Pain Blog Pericarditis 127

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. The case continues. Worrall, C.,

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Dr. Smith's ECG Blog

AUGUST 8, 2020

Haven't you been taught that this favors pericarditis? Weren't you taught that concave morphology favors pericarditis? Expert ECG interpretation can often distinguish normal variant STE from OMI from pericarditis. Smith = “You diagnose acute pericarditis at your peril”. We will study this soon with our database.

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Dr. Smith's ECG Blog

NOVEMBER 13, 2022

Emre is a new Editor of the Blog. You can find many examples on this blog attesting that. I am sure that it is not for the readers of this blog. This is also a clear ECG for the readers of this blog, but may be hard for someone who is not used to seeing non-mainstream ECGs. Written by Emre Aslanger.

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Dr. Smith's ECG Blog

DECEMBER 10, 2019

Echo does not necessarily differentiate acute MI from pericarditis: both may have wall motion abnormalities. Dr. Punjabi has a fantastic radiology blog on Spectral CT: [link] A negative CT should not be relied upon to rule out ischemia. This is why I frequently write: "You diagnose pericarditis at your peril."

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Dr. Smith's ECG Blog

JANUARY 17, 2018

ECG Diagnosis: Normal variant ST Elevation vs. Pericarditis. Uncertain whether there is pericarditis or normal variant. No objective signs of pericarditis (no rub, no effusion, no positional pain) 3. I favor normal variant for several reasons : 1. No active chest pain 2. Normal variant is far more common 4.

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Dr. Smith's ECG Blog

JULY 18, 2014

When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP). What complication is the patient with post-infarction regional pericarditis at risk for? 3) Oliva et al. (4) Lessons : 1. One should be on the alert for myocardial rupture.

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Dr. Smith's ECG Blog

MARCH 26, 2024

We have seen this pattern in many pts with acute right heart strain on this blog. __ Smith : The combination of T-wave inversion in V1-V3 and in lead III is very specific for acute pulmonary embolism. Thus, the ECG could be considered similar to Aslanger's pattern (inferior OMI plus SEI pattern). What is the Diagnosis?

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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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Dr. Smith's ECG Blog

FEBRUARY 6, 2024

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. I've copied KEY points from My Comment in the August 6, 2022 post in Dr. Smith's ECG Blog — regarding the answer to this question.

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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. Nicholson and Meyers provide numerous links at the end of their discussion to insightful related cases of acute PE that we've presented in Dr. Smith's ECG Blog. What is the Diagnosis?

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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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ECG Cases

NOVEMBER 19, 2019

In this ECG Cases blog we look at 8 patients with potentially ischemic symptoms, to highlight pearls and pitfalls of inferior MI. Can you identify which ones had acute coronary occlusion? The post ECG Cases 3: Can you find the subtle inferior MI? appeared first on Emergency Medicine Cases.

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ECG Cases

JANUARY 12, 2021

In this ECG Cases blog we look at 10 patients who presented with ST elevation, and review the differential diagnosis of ST elevation using the ELEVATIONS mnemonic. Which had occlusion MI? The post ECG Cases 17 – ST ELEVATIONS mnemonic and Occlusion MI appeared first on Emergency Medicine Cases.

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Dr. Smith's ECG Blog

JULY 7, 2013

When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP). 3) strongly associated myocardial rupture with postinfarction regional pericarditis (PIRP) , and associated PIRP with persistent upright T-waves. 3) Oliva et al. (3)

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ECG Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.

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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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Dr. Smith's ECG Blog

NOVEMBER 14, 2019

Fortunately, there was an ECG from about a year prior: And here is one from about 10 years prior: You can see here that the computer says "suggests pericarditis" but that I changed it to early repolarization. Just because there is diffuse ST elevation does NOT mean it is pericarditis. A picture is worth 1,000 words.

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Dr. Smith's ECG Blog

MAY 27, 2024

ST depression in lead AVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Kontos et al. 2022 ACC expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department: a report of the American College of Cardiology solution set oversight committee. Bischof et al.

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Dr. Smith's ECG Blog

JANUARY 15, 2024

ECG 2 Especially in the context of the first ECG, readers of this blog will readily appreciate the ST elevations and hyperacute T waves in II, III, aVF, V6, and to a lesser extent V5. The "flu-like" illness suggests myo- or pericarditis, but that would be a diagnosis of exclusion. [link] I also texted the ECG to Dr. Smith.

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Dr. Smith's ECG Blog

MARCH 11, 2016

Post-infarction Regional Pericarditis (PIRP) PIRP happens when MI is transmural, all the way from subendocardium to subepicardium, thus leading to inflammation of the subepicardium (next to the pericardium). MYOCARDIAL RUPTURE AND POSTINFARCTION REGIONAL PERICARDITIS KEY POINTS · Myocardial rupture occurs in 1 to 1.5% Re-occlusion 2.

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