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Difficult echocardiogram after pericardiocentesis

Heart BMJ

Clinical introduction A patient in their 70s, a heavy smoker with low body max index (17 kg/m 2 ) already known for previous relapses of pericarditis on echocardiographic follow-up, was admitted for worsening pericardial effusion ( figure 1A,B ; ).

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Acute chest pain and ST Elevation. CT done to look for aortic dissection.

Dr. Smith's ECG Blog

This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis. Mistaking OMI for pericarditis is a much more harmful error than the converse. The rate is tachycardic, which is uncommon in OMI and common in pericarditis.

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"Pericarditis" strikes again

Dr. Smith's ECG Blog

mm has been described in normal subjects) Overall impression: In my opinion and experience, this ECG most likely represents a normal baseline ECG, but with a small chance of pericarditis instead. I texted this to Dr. Smith without any information, and this was his reply: "This could be pericarditis but probably is normal variant."

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What do you call fluid collection around the heart?

All About Cardiovascular System and Disorders

There are other tests also for tuberculous pericarditis, but they not as sure as growing the bacterium in culture. Sometimes mild pericardial effusion may be detected by an echocardiogram done for other causes. Pericardial effusion is usually confirmed by an echocardiogram (ultrasound study of the heart).

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Chest Pain and Inferior ST Elevation.

Dr. Smith's ECG Blog

PR depression, which suggests pericarditis 4. We also showed that, of 47 cases of pericarditis with ST elevation, none had ST depression in aVL. ) The patient underwent an emergent formal echocardiogram to look for wall motion abnormality: The estimated left ventricular ejection fraction is 63 %. No wall motion abnormality.

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"The dye don't lie".except when it does. Angiogram Negative, or is it?

Dr. Smith's ECG Blog

The patient was thought to have low likelihood of ACS, and cardiology recommended repeat troponin, urine drug testing, and echocardiogram. Bedside echocardiogram showed hypokinesis of the mid to distal anterior wall and apex. Initial hscTnI was 10 ng/L (ref. <14). There was no recommendation for repeat ECG.

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Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 ng/ml)

Dr. Smith's ECG Blog

This rules out pericarditis, which essentially never has reciprocal ST depression. When flow is restored, wall motion may completely recover so that echocardiogram does not detect the previous ischemia. This is not pericarditis because: a. Pericarditis does not have reciprocal depression.

STEMI 52