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ECG Blog #365 — A 30yo with Pericarditis.

Ken Grauer, MD

The patient was discharged with a diagnosis of acute pericarditis — and treated with a full course of colchicine and ibuprofen. The ultimate discharge diagnosis was acute pericarditis. ( See ECG Blog #215 — for more on the Cabrera format. = From the information provided — I would not make the diagnosis of acute pericarditis.

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Pericarditis, or Anterior STEMI? The QRS proves it.

Dr. Smith's ECG Blog

This ECG is diagnostic of anterior STEMI. 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. However, look closely!

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Acute chest pain and ST Elevation. CT done to look for aortic dissection.

Dr. Smith's ECG Blog

This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis. Mistaking OMI for pericarditis is a much more harmful error than the converse. The rate is tachycardic, which is uncommon in OMI and common in pericarditis.

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What does this ECG show?

Dr. Smith's ECG Blog

Overall, this looks like one of the rare ECGs that is actually specific for pericarditis in my opinion. QOH versions 1 and 2 both say Not OMI, with high confidence, without any clinical context, despite the abnormal STE meeting STEMI criteria. Pericarditis maybe." There was no prior ECG for comparison.

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Healthy 45-year-old with chest pain: early repolarization, pericarditis or injury?

Dr. Smith's ECG Blog

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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ECG Cases 27 Pericarditis – Diagnosis of Exclusion

ECG Cases

Jesse McLaren guides us through 9 cases and explains how pericarditis is a diagnosis of exclusion through 3 simple steps: 1. Exclude complications of pericarditis, eg myocarditis, large pericardial effusion 3. Exclude normal variant ST elevation presenting with benign chest pain on this month's ECG Cases blog.

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"Pericarditis" strikes again

Dr. Smith's ECG Blog

mm has been described in normal subjects) Overall impression: In my opinion and experience, this ECG most likely represents a normal baseline ECG, but with a small chance of pericarditis instead. I texted this to Dr. Smith without any information, and this was his reply: "This could be pericarditis but probably is normal variant."