Purulent Pericarditis Presenting With Abnormal Electrocardiogram Consistent With STEMI
Mehrdad Zarghami1, Natasha Garg2, Tetyana Okan3
1Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Internal Medicine, Jamaica Hospital Medical Center, Queens, New York, USA.
Insights
Purulent pericarditis can mimic a heart attack (STEMI) but is a rare infection. Prompt diagnosis and treatment are crucial for this life-threatening condition.
Area of Science:
- Cardiology
- Infectious Diseases
Background:
- Purulent pericarditis is a rare but critical condition, representing less than 1% of all pericardial diseases.
- It poses a significant diagnostic challenge due to its potential to mimic other cardiac emergencies.
Background:
Purulent pericarditis is a rare, life-threatening condition accounting for <1% of pericardial disease.
Case Summary:
A 57-year-old woman with active intravenous drug use and poorly controlled type 2 diabetes presented with chest pain and inferolateral ST-segment elevations. Emergent coronary angiography revealed nonobstructive coronary artery disease. Subsequent echocardiogram revealed a large pericardial effusion with tamponade physiology. Pericardiocentesis drained 600 mL of purulent fluid positive for methicillin-sensitive Staphylococcus aureus.
Discussion:
This case illustrates the diagnostic challenge of "pseudo-STEMI" in the setting of purulent pericarditis and underscores the importance of a rigorous diagnostic approach when angiography fails to identify a culprit lesion, necessitating a broader differential to determine the true underlying pathology.
Related Concept Videos
Pericarditis II: Clinical Features and Diagnostic Tests
Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
Endocarditis II: Clinical Features of Infective Endocarditis
Acute Coronary Syndrome III: Diagnostic Studies
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

