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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).
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.
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.
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.
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.
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