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- 110 bpm
- Sinus rhythm
- PR - Normal (160ms)
- QRS - Normal (80ms)
- QT - 300ms (QTc Bazette 410 ms)
- Widespread ST elevation leads I, II, III, aVF, V2-6
- Concave morphology
- ST Depression lead aVR
- PR depression leads I, II, III, aVF, V4-6
- PR elevation lead aVR
- Down-sloping T-P segment best seen in lead II
- Note sinus tachycardia - ? effusion
What happened ?
The patient was admitted under the cardiology team. Blood tests showed a negative troponin but raised inflammatory markers and D-dimer. A subsequent CTPA showed a pericardial effusion and the patient underwent pericardiocentesis for a large effusion, total drainage of ~900mls of fluid !
The ultimate diagnosis was of viral pericarditis complicated by pericardial effusion.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.