Traumatic Pericarditis

Report:

Sinus tachycardia 100/min

Diffuse ST segment elevation suggests pericarditis

Comment:

The ST segments started to rise within 12 hours of injury and reached maximum at 36 hours, when this tracing was obtained. The admission ECG, taken approximately two hours after the accident, showed no repolarisation abnormalities (Fig 114a); its ST segments are aligned to the baseline TP segments. The PR segments failed to show any significant shifts.

Fully blown typical ECG picture of acute pericarditis is uncommon after blunt trauma to the chest; like arrhythmias or conduction defects of the associated myocardial injury, clinical pericarditis may be delayed hours or days after trauma. The example shown in Spodick’s magnum opus on pericardial disease was obtained 24 hours after a steering-wheel injury84.

Most patients have only nonspecific ST/T changes, not particularly “pericardial” in appearance; the ST segments seldom rise to the occasion!

Whatever the method of detecting pericardial involvement, its demonstration has potentially serious implications: “post-traumatic patients must be followed indefinitely”85.

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