Remove Coronary Angiogram Remove Pericarditis Remove STEMI
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ECG Blog #365 — A 30yo with Pericarditis.

Ken Grauer, MD

Hospital evaluation for this patient was negative for an acute coronary syndrome ( ie, CT coronary angiogram 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.

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What would you do with acute chest pain and this ECG? You might see what the Queen thinks.

Dr. Smith's ECG Blog

His EKG with worse pain now shows enough ST elevation to meet STEMI criteria. Surely, he should be given heparin and taken for an emergent angiogram, right? The undergraduate continues: This new EKG pattern is more suggestive of acute pericarditis. Usually with pericarditis, some degree of PR segment depression is expected.

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A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

50% of LAD STEMIs do not have reciprocal findings in inferior leads, and many LAD OMIs instead have STE and/or HATWs in inferior leads instead. The ECG easily meets STEMI criteria in all leads V2-V6, as well. 24 yo woman with chest pain: Is this STEMI? Pericarditis? Beware a negative Bedside ultrasound.

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A man in his late 30s with acute chest pain and ST elevation

Dr. Smith's ECG Blog

There is a reasonable chance of pericarditis in this case, or this could be a baseline." Here is the Queen of Heart's interpretation: The cath lab had been activated for concern of STEMI. Sadly, I did not receive enough information to adjudicate whether this patient has pericarditis or not. I immediately responded: "cool fake!