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Case Report: ST-Segment Elevation in a Man With Acute Pericarditis.

Yi-Ming Li1, Yu-Heng Jia1, Jiay-Yu Tsauo1

  • 1Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.

Frontiers in Cardiovascular Medicine
|January 11, 2021
PubMed
Summary
This summary is machine-generated.

Acute pericarditis, often mimicking heart attacks, can be fatal. This case highlights the importance of considering pericarditis in chest pain differential diagnoses and recognizing its unique ECG findings for timely intervention.

Keywords:
ECGSTEMIacute pericarditisesophageal perforationpurulent pericarditis

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Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Acute pericarditis is an inflammatory pericardial condition with diverse etiologies.
  • It can present similarly to ST-elevated myocardial infarction (STEMI), complicating diagnosis.
  • Prompt diagnosis is crucial as a small subset of cases can progress rapidly.

Observation:

  • A 52-year-old male presented with chest pain and dyspnea, initially diagnosed as STEMI based on ECG and cardiac markers.
  • Coronary angiography revealed normal coronary arteries, but transthoracic echocardiography showed massive pericardial effusion.
  • Purulent pericarditis was diagnosed following pericardiocentesis and CT scan, revealing pneumomediastinum secondary to suspected esophageal perforation.

Findings:

  • Purulent pericarditis, potentially caused by esophageal perforation, presented with symptoms mimicking STEMI.
  • ECG characteristics suggestive of acute pericarditis include concave and diffused ST-segment elevation and PR segment depression.
  • A high ratio of ST-segment elevation to T wave in lead V6 (>0.24) can aid in diagnosis.

Implications:

  • Chest pain differential diagnosis must include acute pericarditis, which can be critical and fatal.
  • Comprehensive medical history and physical examination are vital for accurate diagnosis.
  • Prompt recognition and differentiation from myocardial infarction are essential for appropriate management.