Myopericarditis

Report:

Sinus rhythm

Global T wave inversion c/c infarction/ischæmia

Comment:

The T waves show deep, if somewhat asymmetrical, inversion. The pain continued and was, at times, severe. Propranolol and nitrates did not help. As the T waves deepened further (Fig 194a), coronary angiography was done, demonstrating normal arteries; the left ventriculogram showed a normal ventricle. The patient’s pain responded to aspirin and indomethacin. The ECG normalised within 12 months.

Final diagnosis is, then, myopericarditis. This is because her initial ECG (not shown) suggested pericarditis, before the T wave inversion. I was sure before the catheter that she had a ‘subendocardial infarction’ (this in 1976), unstable, as evidenced by progressive T wave changes and continued pain. Medicine is a humbling profession.

If you have any suggestions for or feedback on this report, please let us know.