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.

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