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Sent by Dan Singer MD, written by Meyers, edits by Smith A man in his late 30s presented with acute chestpain and normal vitals except tachycardia at about 115 bpm. Dr. Singer sent this to me with just the information: "~40 year old with acute chestpain". Acute pain?" -(Dr. I immediately responded: "cool fake!
A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chestpain radiating to "both axilla" as well as the upper back. She was reportedly "pacing in her room while holding her chest". Clinician and EKG machine read of acute pericarditis.
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
Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chestpain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). The patient was still with ongoing chestpain at the time ECG #1 was done.
Below is the first ECG, signed off by the over-reading cardiologist agreeing with the computer interpretation: ST elevation, consider early repolarization, pericarditis, or injury. Theres ST elevation in V3-4 which meets STEMI criteria, which could be present in either early repolarization, pericarditis or injury. What do you think?
The case reports Case 1 involves a 26 year old man who developed pericarditis after the Pfizer vaccine. Pericarditis, an inflammation of the sac the heart lives in, developed about 7 days after the Pfizer vaccine. The diagnosis was made based on classic findings of inflammation on an electrocardiogram associated with acute chestpain.
Tuberculous pericardial effusion can be documented by aspirating the fluid and culturing the fluid for the presence of the bacteria causing tuberculosis (Mycobacterium tuberculosis). There are other tests also for tuberculous pericarditis, but they not as sure as growing the bacterium in culture.
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.
A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chestpain. Such an out-of-proportion STE is virtually never seen in pericarditis. STE in lead I and II are more subtle.
60-something with h/o MI and stents presented with chestpain radiating to the back and nausea/vomiting. Pericarditis? A straight ST segment virtually never happens in inferior ST elevation that is NOT due to OMI (normal variant, pericarditis) 4. Time zero What do you think? There is inferior ST elevation.
Written by Willy Frick A 40 year old woman was at home cooking when she developed chestpain. 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." She took an oxycodone and called EMS.
Given her reported chestpain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. She was noted to be tachycardic and her heart sounds were distant on physical exam.
Triage documented a complaint of left shoulder pain. 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." See this case: Persistent ChestPain, an Elevated Troponin, and a Normal ECG.
Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chestpain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage.
The emergency medicine physician documented, "His initial EKG is riddled with artifact and difficult to interpret but does not look like a STEMI." This is a very bold statement in a type 1 diabetic with very concerning sounding chestpain. Several hours passed with no documentation as to the reason for delay.
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