Pericarditis

Report:

Sinus rhythm 67/min

First degree AV block

PR interval 0.22”

ST segment elevation c/c pericarditis

Comment:

The features favouring pericarditis are ST elevation in both the frontal and the precordial leads, involvement of V6 and normal QRS and T waves. Early repolarization, the only other differential diagnosis here, should have stayed confined to one set of leads, had large, perhaps terminally notched QRSs and T waves and stayed clear of V6. But one can never be completely sure, except in this case, on other grounds: pericardial pain and rub.

Time course also provides an answer, but most patients with either diagnosis are discharged and booked for remote ECGs and other tests as required.

The first degree AV block is unexplained, except by concomitant myocarditis (a frequent cause of blocks). Two days later (Fig 88a), however, there was no T wave inversion (except in L3) to support it and PR interval disappeared with transient AF. The latter implies an additional pathology to pericarditis; one can only speculate. The patient went straight home from CCU.

Fig 88b is another case, a 75 year old woman who spent 18 months ventilated in ICU for presumptive Guillain-Barré syndrome. Her pericarditis, after a year in ICU, was idiopathic. It was confirmed at autopsy by dense adhesions. She in fact had bronchial carcinoma, with paraneoplastic GBS-like syndrome, missed until the very end. A previously normal ECG is shown below (Fig 88c).