ECG of the Week - 5th February 2018 - Interpretation

The following ECG is from a 35 yr old male who presented with 1 hour of central severe chest pain. He has a past medical history of Type 2 Diabetes and a positive family history. He had recently been unwell with a febrile illness.

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Rate:

• 120 bpm

Rhythm:

• Regular 
• Sinus rhythm 

Axis:

• Normal / Inferior

Intervals:

• PR - Normal (~170ms)
• QRS - Normal (80ms)
• QT - 270ms (QTc Bazette 380 ms)

Additional:

• ST Elevation leads I (<1mm font="">, II (1mm)
• Baseline artifact limits in precordial leads
• ST Elevation leads V1-3 (<=1mm)
• T waves in right precordial leads look prominent
• Relative high voltages in right precordial leads
• Absence of ST depression

Interpretation:

• Sinus tachycardia
• ST segment changes without reciprocal changes

DDx

• Benign Early Repolarisation
• Pericarditis
• ACS - should always be considered when making a diagnosis of pericarditis

The patient underwent a bedside echo which was normal without evidence of pericardial effusion or regional wall motion abnormality.
He was subsequently treated as pericarditis with symptomatic improvement.

References / Further Reading

Life in the Fast Lane

• Pericarditis 

Textbook

• Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.