Localised Traumatic Pericarditis

Report:

Sinus tachycardia 116/min

Anterolateral ST segment elevation

Comment:

The anterolateral ST segment elevation exceeds 5 mm (in V4) and, although saddle-shaped and without obvious reciprocal changes in the inferior leads, striking enough to scare the staff into calling for coronary angiography. The Q waves in the LV leads looked uncomfortably prominent. These were the reasons for transfer from the peripheral hospital. In that situation it is best and simplest to do it.

The study was completely normal, like the one 5 years previously, for atypical pain. An echocardiogram was also normal – no (pericardial) effusion or wall motion abnormalities. It could have been used instead.

The following day the ST segments were less elevated (below, Fig 65a). There were no evolving T wave changes. The tachycardia 132/min was due to pain and large hæmothorax but, the patient being in CCU, treated by digoxin! Sometimes one wonders how medical decisions are arrived at.

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