46: URI & Chest Pain

A 31 year old presents with sore throat, headache, body aches, dry cough, chest pain and fever for 3 days.   He is otherwise healthy and denies any use of tobacco or illicit drugs.

His vital signs are normal except for a temperature of 101.3 and his exam is non-focal except for a runny nose.

The precordial leads from  EKG are shown below.

What does the EKG show?  What should be done next?

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Answer: Myocarditis

This patient had ST elevation in the lateral leads (V5 &v6), which the computer read as “*****ACUTE MI******”.  Cardiology and the ED physician agreed that this was not an AMI, so no cath lab.  The troponin peaked at 29.  The ejection fraction was 40%

MORE ON MYOCARDITIS

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QUICK ESSENTIALS: EMERGENCY MEDICINE Version 4.0

Symptoms:    Fever, chest pain, SOB, CHF.   May have viral syndrome: HA, body aches, sore throat
Tests:    EKG: ST & T?’s, blocks, dysrrhythmias.  Lab: troponis: 33%.  Echo
Causes:     Coxsackie B > other viral, Chaga’s, HIV, influenza, SLE, rheumatic, toxo, Lyme, diphtheria
Meds:    Amphetamine/cocaine, cyclophosphamide…(See A to Z Pocket Pharmacopoeia for more)
Rx:         Treat primary  cause, treat CHF.  Consider: ASA, 650mg, IVIG, prednisone, LMWH

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