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She presented to an outside hospital after several days of malaise and feeling unwell. This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). Sinus tachycardia has many potential causes. Heart rate was in the 80s.
The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. ST depression.
These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. Despite active CP — cath lab activation was deferred and this patient was transported to a local hospital without PCI capability. Usually with pericarditis and myocarditis — hyperacute T waves (HATW) are not present.
They informed me that she had just been hospitalized 10 days ago for "some fluid around the heart" and was discharged after one day without incident. Ultimately, she spent several days in the hospital and no further fluid collected. She was diagnosed with pericarditis and spent one day in the hospital without events.
Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77];P=0.02) years, colchicine did not reduce a composite of emergency department visit, cardiovascular hospitalization, cardioversion, or repeat ablation (29 versus 25 per 100 patient-years; HR, 1.18 [95% CI, 0.69–1.99];P=0.55).CONCLUSIONS:Colchicine
A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Here was the ECG: There is sinus tachycardia. Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? This was sent by a reader. and K was normal. This is "Shark Fin" morphology. So this is STEMI, right?
The ECG shows sinus tachycardia, a narrow, low voltage QRS with alternating amplitudes, no peaked T waves, no QT prolongation, and some minimal ST elevation in II, III, and aVF (without significant reciprocal STD or T wave inversion in aVL). It is difficult to tell if there is collapse during diastole due to the patient’s tachycardia.
You do NOT see this in normal variant STE, nor in pericarditis. After admission to the hospital, the patient was discharged from the hospital without any investigation of his acute MI. Here is the computer interpretation: (Veritas algorithm) This is what I said: "This is diagnostic of an acute inferior MI.
MY Interpretation of Today's Initial ECG: I've labeled key findings in Figure-2 for today's initial ECG: The rhythm is sinus tachycardia at ~105/minute. The sinus tachycardia is a definite concern that something acute may be ongoing. The patient arrested outside the hospital. Figure-2: I've labeled t he initial ECG.
Given his exertional chest pain and elevated troponin, the patient was admitted to the hospital for "NSTEMI" with a plan for left heart catheterization the next day. Dyspnea, Chest pain, Tachypneic, Ill appearing: Bedside Cardiac Echo gives the Diagnosis 31 Year Old Male with RUQ Pain and a History of Pericarditis. incomplete RBBB 1.7
He spent almost 2 months in the hospital, and reportedly made a full neurologic recovery. Dyspnea, Chest pain, Tachypneic, Ill appearing: Bedside Cardiac Echo gives the Diagnosis 31 Year Old Male with RUQ Pain and a History of Pericarditis. This patient arrested shortly after hospital arrival. He was prescribed apixaban.
Other than tachycardia, Other than slight tachycardia, vitals were within normal limits (including oxygen saturation). As always, takotsubo cardiomyopathy and focal pericarditis can mimic OMI, but takotsubo almost never mimics posterior MI, and both are diagnoses of exclusion after a negative cath. Were they right?
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