High ST Elevation in a Patient with Acute Chest Pain

ConclusionThe ECG findings could be due to either dynamic early repolarization (normal variant ST elevation), or to pericarditis, or to acombination of the 2 entities.Yes, normal variant ST elevation can be dynamic:Increasing ST elevation. STEMI vs. dynamic early repolarization vs. pericarditis.ST elevation of early repolarization may vary with the rateChest pain, Dynamic ST Elevation and T-waves, and High VoltageAlternatively, the ECG could represent pericarditis superimposed on early repol.  There certainly was pericarditis, but that does not mean the ECG findings were due to pericarditis.This paradox is extremely well illustrated in this brilliant post31 Year Old Male with RUQ Pain and a History of Pericarditis. Submitted by a Med Student, with Great Commentary on Bias!I do believe that in this age of very sensitive troponins (cTn) that pericarditisthat results in ST Elevation will have at leastdetectable troponins.  We used to differentiate pericarditis from myocarditis using elevation of cTn.  There is no literature on this topic.  This article by my friend Pierre Taboulet is the closest I can find, but was published in 2000, many years before the age of highly sensitive troponins:Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditishttps://academic.oup.com/eurheartj/article/21/10/832/519271p.p1 {margin: 0.1px 0.0px 0.1px 0.2px; font: 11.0px Helvetica}p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px ' Times New ...
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