A 25-year-old male presents to hospital with atypical chest pain. His ECG is shown below

a) Describe the ECG abnormalities?

b) What are the most likely differentials in this patient for these ECG changes?

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College Answer

a)  Widespread concave ST elevation, most prominent in the mid- to left precordial leads (V2-5)
 Notching or slurring at the J-point
 Prominent, slightly asymmetrical T-waves that are concordant with the QRS complexes

b) Pericarditis
 Benign early replolarisation

Discussion

The image above, depicting some pericarditis-like changes, was shamelessly stolen from an excellent LITFL page on pericarditis.

Generally speaking, ECG changes associated with acute pericarditis are diffuse ST segment elevation and PR interval depression.

These changes frequently mimic acute myocardial infarction. Also early repolarisation can look exactly like this. The latter is a stable lifelong appearance, whereas both of the former are evolving pathologies; one might be able to confidently say that serial ECGs will discriminate between them. Additionally, various authors have identified some sophisticated methods by means of which one might be able to tell the difference.

References

References


Marinella, MARK A. "Electrocardiographic manifestations and differential diagnosis of acute pericarditis." American family physician 57.4 (1998): 699-704.


Ginzton, LEONARD E., and MICHAEL M.  Laks. "The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria." Circulation 65.5 (1982): 1004-1009.