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 ).

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

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? If detected early by ultrasound, the patient can be saved. 3) Oliva et al. (4)

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STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

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). If detected early by ultrasound, the patient can be saved. 3) Oliva et al. (3) Ann Emerg Med 1994;23(6):1333-42. Oliva PB, Hammill SC, Edwards WD.

STEMI 52

STEMI Myocardial Infarction Pericarditis Ultrasound 52

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?

Chest Pain 40

Chest Pain Pericarditis Ultrasound Download 40

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.

Chest Pain 65

Chest Pain Blog Arrhythmia Critical Care 65

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

You can easily imagine this patient getting one of several diagnoses -- vasospasm, MINOCA , pericarditis, or maybe even no diagnosis at all beyond "non-obstructive coronary artery disease." Fortunately, this operator used intravascular ultrasound (IVUS). An angiogram is a " lumenogram " and does not "see" the extraluminal plaque.

Plaque 67

Plaque Stents Stent Chest Pain 67

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Dyspnea, Chest pain, Tachypneic, Ill appearing: Bedside Cardiac Echo gives the Diagnosis 31 Year Old Male with RUQ Pain and a History of Pericarditis. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism. Now another, with ultrasound. What is the Diagnosis? This is a quiz.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. This patient is only pseudo-stable. Her pulse is 125.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

DECEMBER 18, 2022

It was notable for a normal cardiac ultrasound with no pericardial fluid, normal LV and RV function (though the quality was not sufficient to evaluate for wall motion abnormalities) and normal IVC dynamics. Bedside ultrasound is another very important piece. Ultrasound can be very helpful to distinguish causes of hypotension.

Chest Pain 40

Chest Pain Ischemia Aortic Aortic valve 40

Dr. Smith's ECG Blog

JANUARY 9, 2023

Pericarditis? Beware a negative Bedside ultrasound. That said — acute MI does occur in younger patients ( witness the case referred to above by Dr. Smith — as well as the links from Dr. Meyers at the end of his discussion that refer to multiple cases published on Dr. Smith’s ECG Blog of young adults with acute MI ).

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

JANUARY 28, 2012

They also did an ED bedside ultrasound, shown here : This shows a large amount of pericardial fluid, with some echogenic structures that appear to be thrombi or fibrinous exudate. Differential of peri-infarct pericardial fluid The differential includes 1) pericarditis with effusion or 2) hemopericardium. Plummer D et al.

Chest Pain 40

Chest Pain STEMI Pericarditis Ultrasound 40

Dr. Smith's ECG Blog

DECEMBER 22, 2010

Myocardial rupture is usually preceded by postinfarction regional pericarditis (PIRP). 5 of 6 presented with chest pain and an ECG indicating reperfusion therapy, but were detected by bedside ultrasound. In a report of 6 cases at our institution (Hennepin County Medical Center), 2 survived with cardiac surgery. Plummer D et al.

Cardiac Arrest 40

Cardiac Arrest Tachycardia STEMI Chest Pain 40

Dr. Smith's ECG Blog

NOVEMBER 21, 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. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism. Now another, with ultrasound. What is the Diagnosis? This is a quiz.

Chest Pain 114

Chest Pain Embolism Pulmonary Tachycardia 114