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Hospital evaluation for this patient was negative for an acute coronary syndrome ( ie, CT coronaryangiogram was normal — troponin was not elevated — and Echo was negative, with no sign of pericardial effusion ). The ultimate discharge diagnosis was acute pericarditis. ( Figure-1: The initial ECG in today's case.
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.
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!
A repeat CT angiogram indicated contrast extension into the ventricular myocardium near the EPD but no lung spillage suggestive of pseudoaneurysm (Picture 1B).She A coronaryangiogram revealed normal arteries, while a left ventriculogram revealed contrast extravasation through the lateral wall (Picture 1C).
Pericarditis? Young people can suffer acute coronary occlusion, whether by typical atherosclerotic plaque rupture, or by coronary anomalies, coronary aneurysms, dissections, spasm, etc. Chest Pain in a Male in his 20's; Inferior ST elevation: Inferior lead "early repol" diagnosed. Beware a negative Bedside ultrasound.
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