ACS mimickers in ER : Wish I call it “ Ischemic ” pleural effusion ?

A middle aged women , with acute onset left sided chest pain and ECG changes was seen by a general physician. He had little hesitation in labeling the patient as  ACS( To be precious he reported the ECG as lateral wall Ischemia) and asked for an echocardiogram to rule out a heart attack  (This is how cardiology is practiced in many areas) . This patient came to my lab  for the Echocardiogram .The echo window was poor , It showed a structurally normal heart and there was no pericardial effusion. I suspected something systemically wrong in this patient and asked for a X ray chest . Subsequent scrutiny of this  patient revealed she had moderate left tuberculous effusion. ECG changes are attributed to this. We know pericardial disease can cause ECG changes that mimic ACS. While pericarditis can elevate the ST segment. Can pleuritis without effsuion cause ECG changes.  What is the demarcation point between pleural from pericardial surface ? What are the ECG features of pleural effusion ? Low voltage qrs. Poor R wave or even q waves QRS axis shifts are due to true anatomical / electrical shifts T wave inversion as in this patent Mechanism of T wave inversion in plural effusion. T wave represents ventricular repolarisation. To be frank I am not able to give an exact mechanism of such  defects in pleural effusion. The following mechanisms are  suggested Left sided pleural effusion can closely mimic pericardial effusion .One can get low voltage QRS in lateral chest lea...
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: acute coronary syndrome Causes of T wave Inversion ECG changes in pleural effusion mechanism of ECG changes in pleural effsuion pleuro pericardial effusion pleuro pericardial ligamnet pleuro pericardial rub Source Type: blogs