Further Analysis Needed or Was It Lead Reversal —Reply

In Reply We appreciate the letters from Kawji and Chang et al regarding our report of migrating localized ST-segment elevation in the setting of acute pericarditis. In response to Kawji ’s comments, we agree that the ST-segment dynamic change in this case was fast. This was seen on the repeated electrocardiogram (ECG) in the emergency department (Figure, B), obtained 25 minutes after the first ECG by emergency medical services (Figure, A). It continued to evolve with migrating ST -segment elevation in localization as seen on the third ECG (Figure, C) obtained 88 minutes after the first ECG, and was followed by diffuse ST-segment elevation in all the leads except aVR and V1. The lack of coronary obstruction on coronary angiogram in the setting of ongoing chest pain along with other findings, including normal ventricular wall motion, normal cardiac troponin level, trivial pericardial effusion on transthoracic echocardiography, and significantly elevated C-reactive protein levels, established the diagnosis of acute pericarditis. We do not doubt that the ECG dynamic change s are due to acute pericarditis.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research