How to miss pericarditis in coronary care unit : Be casual
Posted Mar 18 2011 1:49pm
For a police officer who visit a crime site every one looks as a culprit. For a cardiologist sitting in coronary care unit all chest pain will have to look like an infarct ! Then only he is a cardiologist !
A rare but costly mistake occasionally happens . When a patient with severe chest pain localized to retro sternum with ST elevation in ECG , enters the ER there is absolutely no reason to suspect any condition other than STEMI.
But Medicine is an art we can not take it as granted . Here was a patient who presented with this ECG and one our fellows correctly diagnosed the condition .
Most physicians would have thromolysed this patient or might have wheeled into cath lab. We have such events reported from primary PCI registry .
Key differentiating points
Diffuse ST elevation not confining to a arterial territory
Absence of reciprocal changes
ST segment with concavity upwards.
Echocardiogram and enzymes will be useful
iFAQs in pericarditis
What is the mechanism of ST elevation pericarditis ?
It is actually a zone of epicardial or Sub epicardial injury.
What will be the ECG finding if STEMI is associated with fibrinous pericarditis ?
Double dose of ST elevation .Mimics a re infarction.
What are the dangers of thrombolysing a patient with diffuse pericarditis ?
It can bleed into pericardial space
What will be the ECG finding in localised pericarditis ?