ECG of the Week - 18th August 2014 - Interpretation

This ECG is from a 25 yr old male presenting with 3 days of sharp central chest pain.

Check out the comments on our original post here.

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Rate:

• 110 bpm

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal

Intervals:

• PR - Normal (160ms)
• QRS - Normal (80ms)
• QT - 300ms (QTc Bazette 410 ms)

Segments:

• Widespread ST elevation leads I, II, III, aVF, V2-6
• Concave morphology
• ST Depression lead aVR

Additional:

• PR depression leads I, II, III, aVF, V4-6
• PR elevation lead aVR
• Down-sloping T-P segment best seen in lead II

Interpretation:

• Pericarditis 
• 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

• Pericarditis 

Textbook

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