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.