Acute Pericarditis

Report:

Sinus rhythm

Acute pericarditis

Comment:

The trace is typical Stage I acute pericarditis, with typical ST segment elevation in all the leads except (equally typically) depression aVR and V1112.

Day later, there was an episode of atrial fibrillation (Fig 157a). This, at least, is atypical for uncomplicated acute pericarditis – it implies the presence of a myocardial disease113.

Most cardiologists look at this kind of ECG with an unusual degree of pleasure. The drama of marked ST segment shift is enacted towards a happy ending – the protagonist is about to receive the good news and some aspirin. A global infarction or ischæmia would evoke a different feeling, of concern and pity – and the protagonist would be getting the bad news (and, again, some aspirin).

This patient was fortunate in that he indeed had (recurrent) acute pericarditis, but its relative benefits were lost on him when he also heard that his blood films were diagnostic of acute myeloid leukaemia. Whether the latter had anything to do with reactivation of pericarditis remains unknown.

Interestingly, when he first presented with 2-hour history of persistent chest pain, his ECG was virtually normal (Fig 157b).