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EKG in Pericarditis

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1. EKG in Pericarditis

: EKG in Pericarditis , Electrocardiogram in Pericarditis From Related Chapters II. Indication Suspected III. Efficacy: Test Sensitivity Abnormal EKG changes in 90% of cases All 4 EKG stages seen in <50% of cases EKG changes are most common in (due to inflammatory response) EKG changes are frequently absent in uremic IV. Differential Diagnosis EKG with V. Precautions Exclude on EKG prior to diagnosing VI. Approach Step 1: Evaluate for (any positive finding strongly favors MI) ST depression (outside (...) EKG in Pericarditis EKG in Pericarditis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 EKG in Pericarditis EKG in Pericarditis Aka

2018 FP Notebook

2. Pericarditis

Pericarditis Pericarditis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Pericarditis Last reviewed: February 2019 Last updated: December 2018 Summary Symptoms include sharp, severe retrosternal chest pain worse with inspiration and a supine position. The classic physical finding is a pericardial friction rub. A low-grade fever is often present. Diagnostic signs include diffuse electrocardiographic ST elevations (...) . It can be either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate. It is characterised clinically by a triad of chest pain, pericardial friction rub, and serial electrocardiographic changes. Constrictive pericarditis impedes normal diastolic filling and can be a medium to late complication of acute pericarditis. Pericarditis is the most common disease of the pericardium encountered in clinical practice. History and exam presence of risk factors chest pain pericardial rub

2018 BMJ Best Practice

3. Pericarditis

Pericarditis Pericarditis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Pericarditis Last reviewed: February 2019 Last updated: December 2018 Summary Symptoms include sharp, severe retrosternal chest pain worse with inspiration and a supine position. The classic physical finding is a pericardial friction rub. A low-grade fever is often present. Diagnostic signs include diffuse electrocardiographic ST elevations (...) . It can be either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate. It is characterised clinically by a triad of chest pain, pericardial friction rub, and serial electrocardiographic changes. Constrictive pericarditis impedes normal diastolic filling and can be a medium to late complication of acute pericarditis. Pericarditis is the most common disease of the pericardium encountered in clinical practice. History and exam presence of risk factors chest pain pericardial rub

2018 BMJ Best Practice

4. Typical pericarditis ECG findings after falling from height. The PR segment depression or ST segment elevation? Full Text available with Trip Pro

Typical pericarditis ECG findings after falling from height. The PR segment depression or ST segment elevation? Acute pericarditis (AP) following blunt thoracic trauma is rare and difficult to diagnosis. A 43-year-old man with offered to the emergency department (ED) after falling from height before a week ago. The ECG performed in the ED was abnormal, ECG revealed PR segment depression in leads DII, DIII, aVF, and V3-6 and a preliminary diagnosis of acute inferolateral STEMI was presumed (...) . Patients have evidence of systemic inflammation, including leukocytosis, elevated erythrocyte sedimentation rate. We are reporting a case of post-traumatic acute pericarditis presenting with PR-segment depression and normal cardiac enzymes mimicking acute STEMI.

2017 Turkish journal of emergency medicine

5. Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter's T-waves on prehospital ECG??

of symptoms and who have no prior ecgs to compare with, who then usually sign refusal consent for further observation and leave but I believe patients agree to what you tell them esp when they know you. . Any suggetions to thist? You can't let someone like this go home! tom fiero interesting. its not uncommon that the medic i greet at the ambulance bay might say " ekg was just nsr doc". and i'm almost embarrassed to ask then to dig it out of their pockets, or sometimes to go back to the van to retrieve (...) it. i am implying that i , while i highly respect them, am saying "i have to see that ekg", that i might be "better" at interpretation. but this blog, like many others, bring home the overwhelming point that every ekg, and serial ekg's when warranted, are essential. thanks, guys. tom @ Tom Fiero — I learned the "hard way" that when I was Attending, that I ALWAYS needed to see the ECG being reported on. Even when the providers were highly capable — I would catch things often that were missed

2018 Dr Smith's ECG Blog

6. ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Dr. Smith's ECG Blog: ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Wednesday, December 9, 2015 A young man was in a rollover Motor Vehicle Collision, with a chest laceration and chest pain. He underwent a CT scan of the chest: There is a very small pneumothorax anterior to the heart This image is from slightly lower down: There is a bit of air in the pericardium (...) A troponin returned elevated, so this ECG was recorded: There is some minimal ST elevation in inferior and lateral leads. This is consistent with percarditis. The troponin shows that there is some myocardial damage. Is it myocardial contusion, or myo-pericarditis? Or pericarditis as a result of myocardial contusion? 6 hours later: There is diffuse ST elevation without large T-waves (low T-wave to ST segment ratio, which is typical of pericarditis vs. STEMI). There is PR depression. There is also

2015 Dr Smith's ECG Blog

7. Watch what happens when "pericarditis" and morphine cloud your judgment

Watch what happens when "pericarditis" and morphine cloud your judgment Dr. Smith's ECG Blog: Watch what happens when "pericarditis" and morphine cloud your judgment Tuesday, July 3, 2018 Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain “similar to his prior MI, but worse.” The pain initially started the day prior to presentation. The pain roused (...) anterior OMI at this point. The cardiology fellow and attending review this ECG and again conclude it is pericarditis and begin colchicine and ibuprofen . They also discontinue nitroglycerin drip at this time. This is insanity. Repeat troponin T drawn 20 hours after onset of pain was 0.58 ng/mL. At this point let’s take a look at all the V2-V3 leads we have collected: Side-to-side comparison of all V2-V3 leads. The change in the QRS complex in V2 and V3 tells the story best, demonstrating QRS

2018 Dr Smith's ECG Blog

8. You Diagnose Pericarditis at your Peril (at the Patient's Peril!)

You Diagnose Pericarditis at your Peril (at the Patient's Peril!) Dr. Smith's ECG Blog: You Diagnose Pericarditis at your Peril (at the Patient's Peril!) Wednesday, June 20, 2018 The source of this case is anonymous. A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to "both axilla" as well as the upper back. She was reportedly "pacing in her room while holding her chest". The initial (...) tracing (EKG 1) was obtained. Clinician and EKG machine read of acute pericarditis. What do you think? There is sinus rhythm. There is diffuse ST elevation in II, III, aVF and V3-V6. One might agree with the computer and the clinician because there is inferolateral ST elevation without any reciprocal ST depression. (Bischof and Smith), and that inferolateral ST elevation is the most common distribution for pericarditis, the ST elevation in V3 has "terminal QRS distortion (TQRSD)," (diagnostic of LAD

2018 Dr Smith's ECG Blog

9. Electrocardiographic Early Repolarization

Access article Electrocardiographic Early Repolarization A Scientific Statement From the American Heart Association , MD, Chair , MD, PhD , MBChB, DPhil, FAHA , MD, FAHA , MD, MPH, FAHA , MD , MD, FAHA , MD, MAS , and MD, FAHA MDon behalf of the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology and Council on Functional Genomics and Translational Biology Kristen K. Patton , Patrick T. Ellinor , Michael Ezekowitz , Peter Kowey , Steven (...) , pericarditis, and hypothermia (Osborn waves). , In the absence of these conditions, ERP is considered a variant of the normal electrocardiographic pattern, given its frequency in the population. The study of ER is complicated by the presence of not 1 but several key characteristics that must be considered, including the localization and number of leads in which ERP is present, the character of the QRS complex and J point (notching or slurring), the magnitude and duration of the J-point elevation

2016 American Heart Association

10. Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion Full Text available with Trip Pro

Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion Angiosarcomas are rare cancers accounting for less than 2% of all soft tissue sarcomas. We report the case of an unusual presentation of pleural epithelioid angiosarcoma in a patient with constrictive pericarditis and recurrent pleural effusion. A 62 year old smoker presented with acute chest pain. ECG showed diffuse elevation of ST segments in the precordial leads. After extensive evaluation, he was diagnosed (...) with viral pericarditis and treated with colchicine. Two weeks later the patient presented to the emergency department with a large right pleural effusion. Evaluation of the pleural fluid obtained from a thoracentesis revealed an exudative effusion with negative microbial studies and no evidence of malignant cells. His pleural effusion re-accumulated rapidly, requiring repeated thoracenteses over several weeks. Medical thoracoscopy was performed and pleural biopsy revealed primary pleural epithelioid

2018 Respiratory Medicine Case Reports

11. Acute Pericarditis as a Presentation of Adrenal Insufficiency Full Text available with Trip Pro

evaluation revealed white blood cell count of 16.08 k/cumm with neutrophilia, normal renal function and elevated troponin (0.321 ng/mL, normal 0.000-0.028). An electrocardiogram (EKG) showed sinus tachycardia, low voltage, PR suppression and ST changes consistent with acute pericarditis. Echocardiogram showed small pericardial effusion without tamponade physiology. Infectious workup was negative; she was thought to have acute adrenal insufficiency likely secondary to viral pericarditis. We treated (...) Acute Pericarditis as a Presentation of Adrenal Insufficiency Acute pericarditis as a presenting sign of adrenal insufficiency is rarely reported. We present a rare case that highlights pericarditis as a clinical presentation of secondary adrenal insufficiency later complicated by cardiac tamponade. A 44-year-old lady who presented to the hospital with a one-day history of pleuritic chest pain and shortness of breath. In the emergency room, she had a blood pressure of 70/35 mmHg. Laboratory

2018 Cureus

12. Pericarditis-complicated takotsubo cardiomyopathy in a patient with rheumatoid arthritis Full Text available with Trip Pro

Pericarditis-complicated takotsubo cardiomyopathy in a patient with rheumatoid arthritis A 64-year-old woman with medication-controlled rheumatoid arthritis (RA) was admitted to our hospital complaining of chest pains. An electrocardiogram showed elevated ST-segments in the inferior leads, and inverted T-waves in the left precordial leads. Left ventriculography demonstrated apical ballooning, and cardiac magnetic resonance imaging demonstrated apical ballooning of the left ventricle (...) , and moderate pericardial effusion. The patient was diagnosed with takotsubo cardiomyopathy (TTC), complicated by pericarditis. In the literature, autoimmune disorders have been associated with TTC. We suggest that this patient's pericardial effusion was caused by TTC, and that her coexisting RA might have played a role in the etiology of the significant pericardial fluid accumulation.

2018 Cardiovascular diagnosis and therapy

13. Recurrence of pericarditis after influenza vaccination: a case report and review of the literature Full Text available with Trip Pro

Recurrence of pericarditis after influenza vaccination: a case report and review of the literature This case report describes a patient with pericarditis likely attributed to influenza vaccination (positive rechallenge), with a literature review.A 87-year old patient developed pericarditis after influenza vaccination, with acute chest pain, without ECG abnormalities or increased cardiac enzyme levels. Echocardiogram showed moderate pericardial effusion. Recovery was obtained through steroids (...) One year later, few days after re-immunization, the patient experienced the same symptoms and was admitted to hospital with diagnosis of recurrence of pericarditis with severe pericardial effusion, again treated with steroids. Other possible causes were ruled out and the cardiologist recommended against influenza vaccinations in the future; the patient did not experience recurrence of pericarditis in the following 6 years. Cases of pericarditis following influenza immunization in the literature

2018 BMC pharmacology & toxicology

14. Acute pericarditis following treatment of a metastatic liver tumor with radiofrequency ablation: a case report. Full Text available with Trip Pro

Acute pericarditis following treatment of a metastatic liver tumor with radiofrequency ablation: a case report. Radiofrequency ablation is a common and minimally invasive procedure used to treat liver tumors. However, the potential threat of heat injury to adjacent structures if the hepatic lesion is near the diaphragm is often overlooked and misunderstood. Rare cardiovascular complications have been reported. How best to identify the patients at risk to allow for prompt treatment (...) is an important issue.A 56-year-old man with underlying oral cancer received radiofrequency ablation for a metastatic liver tumor at segment II. Pleuritic chest pain developed on the day after radiofrequency catheter ablation. Diffuse ST elevation and echocardiography showed the new onset of small to moderate pericardial effusion without tamponade sign. Inflammatory markers were also elevated. Acute pericarditis due to heat penetration and stimulation was favored. His symptoms and signs resolved after

2018 BMC Cardiovascular Disorders

15. P-wave terminal force in lead V1 is a predictive indicator for the diagnosis of tuberculous constrictive pericarditis. (Abstract)

, the course of disease and New York Heart Association (NYHA) classification. Besides, echocardiography data also were obtained, including left atrial diameter, left ventricular end-diastolic diameter and left ventricular ejection fraction. In addition, the parameters of electrocardiogram (ECG) were obtained, such as heart rate, the time from the corrected ORS wave origin to T-wave terminal, atrial fibrillation, right bundle branch block, atrial premature beat, and PTFV1 value.No significant differences (...) were found in age, gender, the course of disease, echocardiography results, ECG parameters (in addition to PTFV1) between patients with TCP and patients with tuberculous exudative pericarditis. The percentage of patients located in NYHA class IV in the patients with TCP was significantly higher than those of patients with tuberculous exudative pericarditis (p = 0.041). Moreover, the incidence rate of abnormal PTFV1 (≤ -0.04 mm·s) was obviously higher in patients with TCP than those of patients

2018 Heart & Lung

16. Acute Pericarditis Occurring Three Days after Intravesical Instillation of Mitomycin C after Transurethral Bladder Tumor Resection in a 64-Year-Old Woman Full Text available with Trip Pro

pericarditis symptoms, the patient underwent an urgent coronary angiogram due to elevated cardiac troponin I level, EKG changes, and wall motion abnormalities on her echocardiogram. During her angiogram, it was found that she had multiple stenotic coronary artery lesions, with no acute total coronary occlusions, and percutaneous coronary intervention (PCI) was done with placement of a single drug-eluting stent for a 95% stenotic lesion in the left anterior descending artery. The patient was discharged (...) Acute Pericarditis Occurring Three Days after Intravesical Instillation of Mitomycin C after Transurethral Bladder Tumor Resection in a 64-Year-Old Woman We present a 64-year-old woman who developed symptoms of acute pericarditis three days after undergoing intravesical instillation of mitomycin C following transurethral bladder tumor resection. Mitomycin C is a chemotherapeutic agent which acts by alkylation of DNA and is known to be cardiotoxic when systemically administered. Despite classic

2018 Case reports in cardiology

17. A Patient with Respiratory Failure and a Computer "Normal" ECG

: This is what I said: "This is diagnostic of an acute inferior MI. There is upsloping ST elevation in III, with reciprocal ST depression in aVL. You do NOT see this in normal variant STE, nor in pericarditis. The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW." This was not seen by the providers. He had another ECG 2 hours and 45 minutes later, before being admitted to the ICU: ECG-2: Now it is more obvious (...) A Patient with Respiratory Failure and a Computer "Normal" ECG Dr. Smith's ECG Blog: A Patient with Respiratory Failure and a Computer "Normal" ECG Monday, March 11, 2019 This ECG was presented in a conference. The patient had presented many times for SOB. On this occasion he was intubated for respiratory failure due to presumed asthma. I was asked to interpret his ECG in the conference. I had never seen it before. ECG-1: What do you think I said? Here is the computer interpretation

2019 Dr Smith's ECG Blog

18. The ECG was correct. The angiogram was not.

lesions (control group; n = 594). Nine patients with significant coronary disease, but no identifiable culprit lesion, were excluded. Electrocardiograms (ECGs) from both groups were reviewed by 2 cardiologists blinded to angiographic findings. On expert review of ECGs, 55% of patients in the normal coronaries group had ST-elevation criteria for STEMI (vs 93% in the control group, but the ECG was considered consistent with a diagnosis of STEMI by both observers in only 33% (vs 92% in the control group (...) The ECG was correct. The angiogram was not. Dr. Smith's ECG Blog: The ECG was correct. The angiogram was not. Tuesday, August 13, 2019 This was sent by Cam Mosley and Michael Truax, LSU-Baton Rouge Residency. 74 yo male with previous MI years ago presented with chest pain and nausea. An ECG was recorded: Sinus rhythm with PVCs. What else? My interpretation (and theirs: they activated the cath lab): It is clearly a subtle proximal LAD occlusion (OMI). Why? -- Subtle STE in I, aVL, V2

2019 Dr Smith's ECG Blog

19. EKG in Pericarditis

: EKG in Pericarditis , Electrocardiogram in Pericarditis From Related Chapters II. Indication Suspected III. Efficacy: Test Sensitivity Abnormal EKG changes in 90% of cases All 4 EKG stages seen in <50% of cases EKG changes are most common in (due to inflammatory response) EKG changes are frequently absent in uremic IV. Differential Diagnosis EKG with V. Precautions Exclude on EKG prior to diagnosing VI. Approach Step 1: Evaluate for (any positive finding strongly favors MI) ST depression (outside (...) EKG in Pericarditis EKG in Pericarditis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 EKG in Pericarditis EKG in Pericarditis Aka

2015 FP Notebook

20. I was texted this ECG: "Middle-aged male with Prehospital Cath Lab Activation"

) Second, let's address the limb lead STE Inferior MI? No 1. The inferior STE is limited to lead II, and has significant PR depression 2. There is no reciprocal ST depression in aVL, . High lateral MI? No 1. The STE in I and aVL are associated with flat T-waves 2. There are well formed J-waves 3. There is no reciprocal ST depression in lead III. ECG Diagnosis: Normal variant ST Elevation vs. Pericarditis. No evidence of MI (which is different than saying that the patient does not have MI) Final (...) I was texted this ECG: "Middle-aged male with Prehospital Cath Lab Activation" Dr. Smith's ECG Blog: I was texted this ECG: "Middle-aged male with Prehospital Cath Lab Activation" Wednesday, January 17, 2018 A physician caring for his new arrival, a 50-something with acute chest pain and dyspnea and syncope, texted me this initial ED ED ECG. The computer read was "Marked ST Elevation, ***Acute MI***" No previous ECG was available. What do you think? Computerized QTc = 399 ms My response

2018 Dr Smith's ECG Blog

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