A(typical) Uræmic Pericarditis

Report:

Sinus rhythm 60/min

SVEBs

Diffuse ST segment elevation suggestive of pericarditis

Comment:

This pericarditis ECG is typical, down to PR segment displacement in several leads. The patient also had typical pain and a triphasic rub (which tends to be quite loud in uræmia). Echocardiogram showed moderate pericardial effusion (this often does not, contrary to much teaching, make the rub disappear).

What is atypical is that uræmia rarely produces typical ECG changes – the inflammation does nor penetrate the myocardium – and an ECG like this one should raise the suspicion of intercurrent infection9.

One ECG feature is typical for uræmic state – the heart rate is lower than expected through autonomic impairment (especially in diabetic nephropathy, like in this case) and decreased cardiac adenylate cyclase levels10.

The patient was too far gone and had too many co-morbidities for “active” treatment. He was sent back (from the ICU) to the ward, where he died the next day.

A similar ECG of stage 1 pericarditis, in an otherwise normal and much younger subject, is shown below (Fig 6a). This one was sent home on indomethacin.