Remove Document Remove Ischemia Remove Pericarditis
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You Diagnose Pericarditis at your Peril (at the Patient's Peril!)

Dr. Smith's ECG Blog

Clinician and EKG machine read of acute pericarditis. While it is true that inferior MI has ST depression in aVL 99% of the time (Bischof and Smith), and that inferolateral ST elevation is the most common distribution for pericarditis, the ST elevation in V3 has "terminal QRS distortion (TQRSD)," (diagnostic of LAD occlusion).

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Will this case be flagged for Quality Improvement in the STEMI/NSTEMI Paradigm?

Dr. Smith's ECG Blog

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?

STEMI 79
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Does this T wave pattern mean anything?

Dr. Smith's ECG Blog

Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. Repolarization Alternans — entails beat-to-beat variation in the ST segment and/or T wave. Conduction and Refractoriness Alternans — entails variance of impulse propagation along some par t of the conduction system.

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A middle aged female with "heartburn" and a "normal ECG" per the computer

Dr. Smith's ECG Blog

Haven't you been taught that this favors pericarditis? Weren't you taught that concave morphology favors pericarditis? Weren't you taught that "new tall T wave in V1" is concerning for ischemia, and so this is the opposite? Expert ECG interpretation can often distinguish normal variant STE from OMI from pericarditis.

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Inferior Subtle ST elevation: straight ST segment, but also no reciprocal ST depression in aVL: which is more important?

Dr. Smith's ECG Blog

Pericarditis? For coronary anatomy, see here: [link] This is the post intervention ECG: All ST Elevation is gone (more proof that it was all a result of ischemia) Formal Echo: Normal estimated left ventricular ejection fraction - 55%. More likely, these T waves probably reflect ischemia of uncertain age. Is it normal variant?

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A woman in her 20s with syncope

Dr. Smith's ECG Blog

The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. Less common etiologies include uremia, bacterial or tubercular pericarditis, chronic idiopathic pericarditis, hemorrhage, and other causes such as autoimmune diseases, radiation, myxedema, etc.

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Brugada Syndrome: Diagnosis and Risk Stratification

All About Cardiovascular System and Disorders

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. Spontaneous type 1 ECG has the highest number of points at 3.5, while fever-induced type 1 ECG has 3 points.