ECG of the Week - 24th December 2018 - Interpretation

The following ECG is from a 30 yr old male who presented with a 48 hour history of positional left sided chest pain. He is normally fit and well.

Click to enlarge

Rate:

• 84 bpm

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal

Intervals:

• PR - Normal (~200ms)
• QRS - Normal (100ms)
• QT - 340ms (QTc Bazette 400 ms)

Additional:

• ST Elevation leads I, II, III, aVF, V1-6
• Concave morphology
• ST Depression lead aVR
• PR depression globally (expect aVL & aVR)

Interpretation:

• Clinical history and ECG features consistent with pericarditis
• Potential element of underlying BERP - no old ECG's to compare

What happened ?

The patient had negative serial troponins and an echo which did not show a pericardial effusion. A diagnosis of uncomplicated pericarditis was made and he was discharged with NSAIDs.

Pericarditis has multiple causes including:

• Infective - viral, bacterial, fungal, TB
• Auto-immune - SLE
• Malignant
• Uraemic
• Traumatic
• Post myocardial infarction
• Post surgical
• Post radiotherapy
• Drug induced

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.