You Diagnose Pericarditis at your Peril (at the Patient ' s Peril!)

The source of this case is anonymous.A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to " both axilla " as well as the upper back.  She was reportedly " pacing in her room while holding her chest " .The initial tracing (EKG 1) was obtained.Clinician and EKG machine read of acute pericarditis.What do you think?There is sinus rhythm.  There is diffuse ST elevation in II, III, aVF and V3-V6.  One might agree with the computer and the clinician because there is inferolateral ST elevation without any reciprocal ST depression. While it is true that inferior MI has ST depression in aVL 99% of the time (Bischof and Smith),andthat inferolateral ST elevation is the most common distribution for pericarditis,the ST elevation in V3 has " terminal QRS distortion (TQRSD), " (diagnostic of LAD occlusion). Paper published: Terminal QRS distortion not found in any ECG of Early RepolarizationTQRSD is defined as the absence of BOTH an S-wave and a J-wave in leads V2or V3.  While I have shown that early repolarization never has this feature which is common to LAD occlusion, no one has ever studied it in pericarditis.  I strongly suspect that pericarditis does not have this feature, and would never assume that it might.  When I see this feature, the ECG represents LAD occlusion until proven otherwise.First, this is so clearly an LAD occlusio...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs