31 Year Old Male with RUQ Pain and a History of Pericarditis. Submitted by a Med Student, with Great Commentary on Bias!

This was submitted by a fantastic medical student who wished to remain anonymous: A 31 year old male with a history of viral pericarditis one year ago presented with right upper quadrant pain. Here is his initial ED ECG:The R-wave in V4 extends to 33 mm, the computerized QTc is 372 msThe only available previous ECG is from one year ago, during the admission when he was diagnosed with pericarditis:1 year ago ECG, with clinician and computer interpretatioin of pericarditis What do you think? What do these EKGs show? What is your plan for this patient?Here was the story from my perspective, prospectively:I was shown this ECG and told that it belonged to a 31 year old male with a history of pericarditis who has RUQ and back pain. Without seeing the patient, my interpretation of the first ECG was: likely normal variant ST-elevation (early repolarization), with a small possibility of pericarditis, and almost no possibility of acute coronary occlusion (STEMI). I was immediately suspicious that this patient had never actually had pericarditis in the past – it seemed much more likely to me this could simply be his baseline ECG which gets repeatedly misinterpreted as pericarditis, with more and more diagnostic momentum each time that he presented with his “history of pericarditis” and any nonspecific symptom near his chest. So let’s take another look at the ECGs:Sinus rhythm at around 70bpm. High voltage in the precordial leads. Obvious ST elevation is present in V2-V6, I, aVL,...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs