Post-CABG ST Segment Elevation

Report:

Sinus tachycardia 112/min

Diffuse ST segment elevation consistent with pericarditis

Comment:

This is indistinguishable from acute pericarditis, down to PR segment displacement. Yet it is difficult to name it – it is obviously a different species, post-thoracotomy. It is due to epicardial injury during the placement of the CABGs and does not, per se, have any more significance than Hamman’s crunch or pericardial rub in this setting.

The patient, however, did have an early tamponade and required urgent thoracotomy in ICU; not surprisingly, his sternotomy wound became infected. His ECG, on the other hand, had no specific information to contribute, because postoperative ST segment elevation is so common. There was, admittedly, some tachycardia, but its causes are legion.

The trace is included here as an example of the pattern of acute pericarditis.

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