I have put up one post with 10 similar cases here . Pay particular attention to aVL which, in patients with inferior wall STEMI, may show T-wave inversion or extremely subtle reciprocal ST depression. There is a change. The most important change, though, is the ST elevation in inferior leads and the reciprocal depression in aVL.This comparison makes it obvious that the new ST elevation is diffuse: inferior, anterior, lateral. ST elevation in all leads that is not inconsistent with early repol or pericarditis, especially since there is J-wave notching (in lead aVL). All ad revenue will go to my ECG research projects. It’s 11 pm on a busy ED shift.

QTc 375. Later on only T abnormalities, usually negative waves, are present and these occur in all leads. It is worth a moment noting that leads III and aVL in the Presentation ECG DO show that magical “mirror-image” picture that is so helpful in identifying acute coronary occlusion (ie, scooped even-though-not-really-depressed ST segment in lead aVL — that if “flipped up” will give ST coving [albeit not-really-ST-elevation in lead III).

One should suspect that this is reciprocal ST depression.Here there is none of the ST elevation seen in the above ECG. So how can one reliably distinguish pericarditis from STEMI?If any of the following are present, a STEMI is more likely:Mark Yoffe, MD, a hospital-based internal medicine doctor, is a medical editor and reviewer. Except for aVR. Written by Meyers, edits by Smith: A female in her 60s presented complaining of 2-3 days of fatigue and shortness of breath.

Now the difference in ST segments become more evident: new ST elevation in II, III, and aVF, with reciprocal ST depression in aVL.Dr. Patient identifiers have been redacted or patient consent has been obtained. Unfortunately, due to an increase in SPAM — we have had to restrict commenting to Users with a GOOGLE Account. Dr. Patwari did a great review on differentiating ST elevations associated with pericarditis vs. acute MI. Use the "label" below the archive (below) to search for all kinds of ECG cases, with discussion. However, look closely at aVL: there is actually a bit of ST depression here. I was reminded of it. Post was not sent - check your email addresses! And so I thought I would repost it. Pericarditis vs. MI. The classic feature of chest pain and dyspnea with pericarditis may be subtle and can be confused with other diagnoses, particularly in elderly individuals.
Prolonged QTc is often seen wit… THANK YOU for your continued support! Pericarditis vs STEMI. Share this: Click to share on Twitter (Opens in new window) Liver disease has been noted in asymptomatic constrictive pericarditis. THANK YOU for your support!I highly recommend using this blog as an atlas or textbook. She called ...Sinus. Be careful not to confuse pericarditis with esophageal disorders, costochondritis, or other causes of noncardiac chest pain.

Comments give US feedback on how well Dr. Smith’s ECG Blog is addressing your needs — and they help to clarify concepts of interest to all readers. Given an overall lack of specificity of clinical f…
Thus the difference between Myocarditis and Pericarditis lies in their place of inflammation. If any of the following are present, a STEMI is more likely: 1. reciprocal ST depressions in any leads other than V1 or aVR. This initial ECG is timeless in its relevance. It could be present in myocarditis but that may only be diagnosed after an angiogram shows no culprit. THANKS for reposting this insightful case! (Please do this judiciously! Up until now, my wife and I have funded the PERFECT (Paced ECG Requiring Fast Emergent Coronary Therapy) study by making her the full time coordinator without pay. If you do not yet have a Google account — it should not take long to register. Pericarditis may occur after renal transplantation, which may be related to uremia or infections (eg, cytomegalovirus [CMV]). You have just seen a 58 year old male with chest pain. Classic teaching of generalised concave up ST elevation and PR elevation in aVR is not reliable for distinguishing pericarditis from ST elevation myocardial infarction (STEMI). 2. straight or concave (“tombstone”) ST segments 3.


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