Clinical Case 051: Cardiac conundrum

This week’s case is “chest pain” in a relatively young man.

I am going to make it tricky by giving you info bit by bit – see if you smart buggers can work it out.

Step 1 – here is the initial ECG.  2 hours of central chest pain.  What is happening?  what are you going to do?

Does he meet criteria for thrombolysis?

OK – so you all seem to agree he has pericarditis on the ECG.  And the history was convincing – 23 yo, pleuritic left chest pain, radiating to the left arm.  He had a story of an acute “strept throat” and was just finished a week of oral penicillin.  BUT – the initial tropT was 0.88, and in the morning it was up to 16!  So he clearly has more than a simple pericarditis.

Just to be sure, late at night I did a bedside ECHO to check if he had anything suspicious.  This showed a small pericardial effusion and no “eyeball” evidence of regional (inferior) wall motion abnormality (for what it is worth with me – an ECHO gumby looking with my eyeballs!)

So lets say he has a myopericarditis.  Let us now look at the treatment.  How do you manage this?  And if you are super-smart – are there any other causes to consider other than “viral”?

If you are unaware of Dr Smith’s ECG blog then check out the section on pericarditis here – lots of pearls for telling MI from pericaritis.

Let me know on he comments.


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