Pericarditis and Ultrasound - Cardiovascular Update

Pericarditis

Dr. Sanjay Gupta

DECEMBER 19, 2022

Pericarditis refers to inflammation of the pericardium The pericardium is a sac within which the heart sits. Acute inflammation of this sac is known as acute pericarditis. About 5% of patients who present to A+E with chest pain which is not deemed to be a heart attack or angina are ultimately diagnosed with pericarditis.

Pericarditis

Pericarditis Heart attacks Heart Attack Chest Pain

"Pericarditis" strikes again

Dr. Smith's ECG Blog

DECEMBER 13, 2019

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."

Pericarditis

Pericarditis Chest Pain Aortic Blog

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

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).

Pericarditis

Pericarditis Chest Pain Blog Ultrasound

What do you call fluid collection around the heart?

All About Cardiovascular System and Disorders

APRIL 25, 2024

There are other tests also for tuberculous pericarditis, but they not as sure as growing the bacterium in culture. Pericardial effusion is usually confirmed by an echocardiogram (ultrasound study of the heart). In addition to cancer and tuberculosis, any other cause of pericarditis can also cause pericardial effusion.

Pericarditis

Pericarditis Cancer Blood Pressure Heart Valves

A woman in her 40s with acute chest pain and shortness of breath

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

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.

A man in his 50s with shortness of breath

Dr. Smith's ECG Blog

MARCH 26, 2024

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.

Chest Pain

Chest Pain Embolism Pulmonary Ischemia

A 20-something with intermittent then acute chest pain

Dr. Smith's ECG Blog

APRIL 25, 2023

No pericardial effusion on ultrasound." First, many on Twitter said "Pericarditis". This is NOT pericarditis, which virtually NEVER has ST depression any where except aVR. ECG diffuse ST elevation, but lacking pericarditis features, and very concerning for acute injury." What do you think?

Chest Pain

Chest Pain Pericarditis Blog Cardiomyopathy

Chest Pain and Inferior ST Elevation.

Dr. Smith's ECG Blog

JUNE 17, 2018

PR depression, which suggests pericarditis 4. We also showed that, of 47 cases of pericarditis with ST elevation, none had ST depression in aVL. ) I’ll add the following 2 comments: i ) This patient presumably has effusive-constrictive pericarditis. Absence of any ST depression in aVL. ( Clin Cardiol 22:334-344, 1999 ).

Chest Pain

Chest Pain Pericarditis Tachycardia Myocardial Infarction

Viral symptoms, then acute chest pain and this ECG. What do you do?

Dr. Smith's ECG Blog

JANUARY 10, 2020

It could also be due to pericarditis or myocarditis, but I always say that "you diagnose pericarditis at your peril." The clinical presentation is very suggestive of myo-pericarditis. But one should always remember that acute MI is a far more common pathology than myo- or pericarditis. Pericarditis?

Chest Pain

Chest Pain Pericarditis Ultrasound Download

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

Dr. Smith's ECG Blog

JUNE 18, 2011

1.196 x STE60 in V3 in mm) + (0.059 x computerized QTc) - (0.326 x RA in V4 in mm) Third, one can do an immediate cardiac ultrasound. This rules out pericarditis, which essentially never has reciprocal ST depression. A bedside ultrasound was done by an emergency physician and simultaneously read by a cardiologist.

STEMI

STEMI Pericarditis Hospital Aneurysm

A woman in her 70s with chest pain

Dr. Smith's ECG Blog

DECEMBER 18, 2022

It was notable for a normal cardiac ultrasound with no pericardial fluid, normal LV and RV function (though the quality was not sufficient to evaluate for wall motion abnormalities) and normal IVC dynamics. Bedside ultrasound is another very important piece. Ultrasound can be very helpful to distinguish causes of hypotension.

Chest Pain

Chest Pain Ischemia Aortic Aortic valve

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

Dr. Smith's ECG Blog

JULY 18, 2014

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? If detected early by ultrasound, the patient can be saved. 3) Oliva et al. (4)

STEMI

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

JUNE 17, 2024

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.

Chest Pain

Chest Pain Embolism Pulmonary Tachycardia

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

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

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.

Plaque

Plaque Stents Stent Chest Pain

A woman in her 20s with syncope

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

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. This patient is only pseudo-stable. Her pulse is 125.

Pericarditis

Pericarditis Tachycardia Ultrasound Blood Pressure

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

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.

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

JANUARY 15, 2024

A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW. The "flu-like" illness suggests myo- or pericarditis, but that would be a diagnosis of exclusion. Smith comment: this is diagnostic of OMI until proven otherwise.

Chest Pain

Chest Pain Blog Critical Care Arrhythmia

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

JANUARY 9, 2023

Pericarditis? Beware a negative Bedside ultrasound. They still would not do angiography for her: See other cases of young patients with OMI: A 16 year old girl has syncope while playing basketball. Chest Pain in a Male in his 20's; Inferior ST elevation: Inferior lead "early repol" diagnosed. 24 yo woman with chest pain: Is this STEMI?

Chest Pain

Chest Pain Aneurysm STEMI Thrombosis

Pericarditis

"Pericarditis" strikes again

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

What do you call fluid collection around the heart?

A woman in her 40s with acute chest pain and shortness of breath

A man in his 50s with shortness of breath

A 20-something with intermittent then acute chest pain

Chest Pain and Inferior ST Elevation.

Viral symptoms, then acute chest pain and this ECG. What do you do?

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

A woman in her 70s with chest pain

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

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

A woman in her 20s with syncope

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Noisy, low amplitude ECG in a patient with chest pain

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

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