Dr. Smith's ECG Blog

JUNE 20, 2018

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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Pericarditis Chest Pain Blog Ultrasound 52

Frontiers in Cardiovascular Medicine

MARCH 17, 2024

TB pericarditis is the commonest cardiac manifestation of TB and is the leading cause of constrictive pericarditis, a reversible (by surgical pericardiectomy) cause of diastolic heart failure in endemic areas. Subsequently, risk stratification strategies for constrictive outcomes have remained unsatisfactory.

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Pericarditis Heart Failure Research Outcomes 49

Dr. Smith's ECG Blog

JULY 3, 2018

06:44 - T-waves in V2 are smaller now - Overall resolution of prior findings (which qualifies as a dynamic change) The initial note by the cardiologist states that the presentation is more consistent with pericarditis. Remember, pericarditis is the thing you say and write down when youre actively trying to miss an OMI.

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Pericarditis Chest Pain Stent Stents 52

Journal of Cardiovascular Pharmacology

MAY 9, 2023

Recurrent pericarditis (RP) is the most troublesome complication of acute pericarditis reflecting an unresolving inflammation of the pericardial sac around the heart and associated with significant morbidity.

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Pericarditis Quality of Life Outcomes Article 40

Dr. Smith's ECG Blog

MAY 16, 2023

There is a reasonable chance of pericarditis in this case, or this could be a baseline." Other outcome information is not available. Sadly, I did not receive enough information to adjudicate whether this patient has pericarditis or not. But I would cath unless there is some clear clinical feature that points to pericarditis.

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Chest Pain Pericarditis Tachycardia STEMI 52

Circulation: Arrhythmia and Electrophysiology

DECEMBER 19, 2024

There were no incidences of adverse event fistula, diaphragmatic paralysis, MI, pericarditis, thromboembolism, PV stenosis, transient ischemic attack, or death. Circulation: Arrhythmia and Electrophysiology, Ahead of Print. BACKGROUND:Pulsed field ablation (PFA) is a promising treatment for atrial fibrillation.

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Atrial Fibrillation Ablation Arrhythmia Outcomes 40

Dr. Smith's ECG Blog

JULY 18, 2014

such Q-waves are associated with larger MI and worse outcomes (2. When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP). What complication is the patient with post-infarction regional pericarditis at risk for?

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STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

JULY 7, 2013

and these are associated with larger MI and worse outcomes (2. When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP). Although the patient has had pain for 4 days, could the artery have fully occluded only within hours?

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STEMI Myocardial Infarction Pericarditis Ultrasound 52

DAIC

MARCH 28, 2024

Twelve-month outcomes data from the pilot phase of the admIRE study, which assessed the safety and efficacy of the VARIPULSE Platform among U.S. Pulsed Field Ablation Using a Variable Loop Circular Catheter with 3D Mapping Integration: Early Outcomes of the admIRE Study [abstract]. In: AF Symposium.; February 2-4; Boston.

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Atrial Fibrillation AFIB Ablation Pulmonary 110

Dr. Smith's ECG Blog

AUGUST 6, 2024

These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. Usually with pericarditis and myocarditis — hyperacute T waves (HATW) are not present. S mith : there is STE in lead III and reciprocal STD in aVL. This is OMI until proven otherwise.

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Chest Pain Ischemia Pericarditis Tachycardia 104

Dr. Paddy Barrett

APRIL 5, 2024

Traditionally used as an anti-inflammatory for pericarditis (inflammation of the lining of the heart), it has recently been shown to result in fewer major heart events in those with a recent heart attack. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. It is an easy win, frequently missed. N Engl J Med.

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Heart Disease Coronary Artery Disease Heart Attack Heart attacks 119

Dr. Smith's ECG Blog

MARCH 11, 2016

Post-infarction Regional Pericarditis (PIRP) PIRP happens when MI is transmural, all the way from subendocardium to subepicardium, thus leading to inflammation of the subepicardium (next to the pericardium). MYOCARDIAL RUPTURE AND POSTINFARCTION REGIONAL PERICARDITIS KEY POINTS · Myocardial rupture occurs in 1 to 1.5% Re-occlusion 2.

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Myocardial Infarction Pericarditis STEMI Angina 52

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." St depression in lead AVL differentiates inferior st-elevation myocardial infarction from pericarditis. link] Bischof, J. Worrall, C.,

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Myocardial Infarction Chest Pain STEMI Blood Pressure 123

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Queen of hearts interpretations: Patient 1, ECG1: Patient 2, ECG1: Patient 1 Clinical Course and Outcome: The EM physician did not see that the S wave voltage has been truncated and squared off at 10 mm, thereby greatly limiting the assessment of proportionality. He diagnosed anterior "STEMI" and activated the cath lab. But he did well.

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STEMI Chest Pain Blog Pericarditis 125

Dr. Smith's ECG Blog

OCTOBER 5, 2011

T-wave to ST ratio is greater than 4 in lead V6, making pericarditis unlikely (also there were no symptoms of pericarditis). Long-term outcome associated with early repolarization on electrocardiography. There is ST elevation diffusely: 2 mm in V2, 3.5 mm in V3, 2.5 mm in V4, 1.5 mm in V5, and 1 mm in V6, 1.5

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Chest Pain STEMI Pericarditis Cardiac Arrest 52

Dr. Smith's ECG Blog

MARCH 27, 2025

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?

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STEMI Chest Pain Pericarditis Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2017

Peak troponin, echocardiographic findings, and long term outcome are unknown. On day 3 of hospitalization she underwent coronary angiography, revealing a 95% lesion in the mid-LAD which was stented. One can say with full confidence that is was completely occluded at the time of the presentation ECG. Learning Points: 1.

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Chest Pain Pericarditis Embolism Stent 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

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. Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). ST depression. Myocardial Contusion?

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Ken Grauer, MD

SEPTEMBER 21, 2024

Pericarditis is rare — but myocarditis is not , so especially in this age group — more information is needed to quickly determine if this could be an acute MI, myocarditis, or none of the above. To quote Dr. Stephen Smith: "The worst risk factor for a bad outcome in acute MI is young age."

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Chest Pain Blog Thrombosis Tachycardia 118

Dr. Smith's ECG Blog

OCTOBER 8, 2023

ECG#1 ECG#2 ECG#3 ECG#4 ECG#5 See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation. All of the patients presented with chest pain , and they are all in triage. Which, if any, of these patients has OMI, with myocardium at risk and need for emergent PCI? YOU TOO CAN HAVE THE PM Cardio AI BOT!!

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Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 123

Dr. Smith's ECG Blog

OCTOBER 11, 2020

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. Could this outcome have been prevented with emergent cath? His first troponin returned "elevated" (level not available).

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Chest Pain STEMI Blog Tachycardia 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

Smith Major Learning Point: The worst risk factor for a bad outcome in OMI is young age because cardiologists cannot believe that a young person can have an OMI. Pericarditis? He was readmitted a few weeks later for a heart failure exacerbation, diuresed, and discharged again. This gets drilled into them.

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Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

JANUARY 12, 2023

False Positive ST elevation in aVL Even when the story is obvious, with intractable pain, the STEMI paradigm can cause preventable delays Man in his 60's with very subtle ECG and pain not controlled with medical therapy Pericarditis vs. MI #2 See other "Quiz Posts": Quiz post - which of these, if any, are OMI? Will you activate the cath lab?

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Chest Pain STEMI Blog Stenosis 52

Circulation

NOVEMBER 11, 2024

To-date no larger studies have assessed sub-clinical myocardial mechanics in acute tuberculous pericarditis (ATBP) and age/sex/ethnic differences, and synergistic-prognostic association of these parameters with patients' outcomes (survival).Aim:To

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Pericarditis Biomarkers Heart Failure Outcomes 40

Dr. Smith's ECG Blog

JANUARY 17, 2024

The initial computer and final cardiology interpretation was a differential: “ST elevation, consider early repolarization, pericarditis, or injury.” But STEMI criteria ignore all this and look at ST segments in isolation. Based on STEMI criteria and unhelpful computer interpretation, the patient was rushed to the cath lab.

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Chest Pain STEMI Myocardial Infarction Blog 118

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

The exception is with postinfarction pericarditis , in which a completed transmural infarct results in inflammation of the subepicardial myocardium and STE in the distribution of the infarct, and which results in increased STE and large upright T-waves. These findings together are more commonly seen with pericarditis.

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Chest Pain Pericarditis Myocardial Infarction Dementia 89

Dr. Smith's ECG Blog

NOVEMBER 30, 2024

In addition, ischemic STD in aVL is highly sensitive for inferior OMI, and excludes pericarditis. for both pericarditis and normal variant, the vector results in more STE in II than III, and absence of STD in aVL. It means that, if there is STD in aVL, then it is almost certainly not pericarditis (but could be myocarditis).

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STEMI Chest Pain Pericarditis Coronary Artery Disease 119

Heart BMJ

NOVEMBER 19, 2024

Background Studies predating widespread COVID-19 vaccination identified patients with congenital heart disease (CHD) as a group at increased risk of severe outcomes from COVID-19. Here we evaluate the impact of vaccination on COVID-19 outcomes among patients with CHD.

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COVID-19 Congenital Heart Disease Congenital Heart Disease 59