He was afebrile at presentation with a blood pressure of 85mmHg systolic.
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- 132 bpm
- Atrial fibrillation
- Irregular rhythm
- Fibrillatory waves visible in leads V1-2
- QRS - Normal (80ms)
- ST Elevation leads I, II, aVL, aVF, V1-6
- ST Depression lead aVR
- Atrial Fibrillation with rapid ventricular response
- Diffuse ST segment elevation
The patient had an urgent echo which showed no significant regional wall motion abnormality or pericardial effusion.
He was investigated and treated for potential sepsis, malignancy, auto-immune disease and vasculitis. Further investigation revealed an OM1 stenosis but this was not felt to be a culprit lesion.
The final diagnosis was one of pneumonia with SIRS and a myo-pericarditis.
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.