Wednesday, 26 December 2018

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

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