ECG experts discuss strategies such as looking at morphology of ST-segments (i.e. Anterior STEMI ST axis is anterior, unless it is proximal LAD occlusion, in which case it is anterior and superolateral (with ST depression in II, III, aVF). !Thanks Ken, have attributed accordingly, and found a quote from the old days… Beta-blocker and Calcium-channel blocker toxicity

I then read a...

Pericarditis does not have reciprocal ST depression, not in either lead aVL or in V2. Prolonged QTc is often seen wit… Continue for 1 week2 Colchicine 0.5mg bd if >70kg and 0.5mg daily if <70kg. In deciding between STEMI vs. pericarditis, name 2 findings which strongly favor the correct diagnosis over the other. It can be due to immune causes such as SLE.It can also be caused by trauma, medications and patient may present post MI. ST elevation and PR depression.

I had a great case just over a...

-My approach is to treat him as a pericarditis. Master ECG interpretation from our nationally-known educators. NEJM 371;25, Dec 18 2014 pp 2410-2416Maisch B et al. Acute Pericarditis.

Again, note that STEMI can have all 3 morphologies, while pericarditis will typically only have concave ST elevations. If YES, it’s a STEMI . I have a lot of questions. Some factors that support STEMI over pericarditis are:The below EKG has the classic findings of pericarditis:  diffuse ST elevations, PR elevation in aVR, STE in lead II>lead III. If any of the following are present, a STEMI is more likely: 1. reciprocal ST depressions in any leads other than V1 or aVR. Characteristics of ST elevations in STEMI. She had no chest pain and cardiac biomarkers were normal. He’s recently had a viral illness but has no other medical history. Stages of Pericarditis. If a patient is going home they probably can also have a more formal outpatient ECHO.1 NSAIDS 600-800mg 6-8/24 or Aspirin 2-4g daily in divided doses. This patient volunteered that he had a recent viral illness, which helps us with the diagnosis.CRP- this gives an indication of the progress of the disease and may be helpful if admitted1 CXR- may show a widened mediastinum and alert you to a pericardial effusionECHO – we can do a bedside echo looking for a significant pericardial effusion.

Classically pericardititis has PR-depression in viral pericarditis (or PR-elevation in AVR) Less reliable in post-MI patients and those with baseline ECG abnormalities; PR-depression is often early and transient in pericarditis; In STEMI, PR-depression is associated with atrial injury, though usually not as marked as in viral pericarditis His vitals are normal.Is this a pericarditis, or Benign Early Repolarisation(BER) or ST elevation myocardial Infarction(STEMI)?To diagnose pericarditis we need a minimum of 2 of the following 4 criteria:   -Especially pleuritic pain, preacordial or retrosternal, relieved by sitting forward   -Pain that radiates to trapezius ridge(2) (considered pathognomonic)             Not too tall, not too small, normal morphology and no clumping1 There is J-point notching in V4 which is more consistent with BER.2 The ST Segment/T wave ratio is ¼ = 0.25- this doesn’t help us as >0.25 = pericarditis.My diagnosis in this case is that this is probably acute pericarditis on the background of BER.How to differentiate Pericarditis from Benign Early Repolarisation (BER)? There are changes in his ECG that support that, however there are also changes that support BER. If you are able to answer NO to ALL of the above: THEN look for PR depression in MULTIPLE leads and a (usually transient) friction rub. Heart Fail Rev 2013;18;355-360Imazio M et al. concavity or convexity), but this is not always accurate. Think pericarditis when there is diffuse ST elevation. However there is no evidence of a STEMI. PR depression is NOT specific for pericarditis.

Continue for 3 months(4)What about steroids as the anti-inflammatory agent of choice.

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