ECG4: to GH

History:

A patient in their mid-30’s with no PMH is BIBA for episodic dizziness and chest pain and nausea both yesterday and today.  The pain was 9/10 but is now gone after 0.4 SL nitro.  He denies SOB or other complaints

Exam:

Vital signs are normal except for bradycardia.  Physical exam is unremarkable

An ECG is done

Computer Read: SB at 55, IRBBB, ST elevation c/w injury, pericarditis or BER.  There was no old ECG available for comparison but a repeat ECG was unchanged.

 

What is the most likely cause of the ECG findings in this patient?

  • A) Anxiety/Panic 
  • B) Blood clot (PE)
  • C) Cardiac: ACS
  • D) Pericarditis
  • E) Electrolyte issue 

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ECG ANALYSIS, QUIZ ANSWER, CASE OUTCOME/PEARLS & 1-MINUTE CONSULT: 

My ECG interpretation (by Dr. D. Brady Pregerson of ERpocketbooks.com): there is no PR depression.  There is anterior and lateral ST elevation without reciprocal changes.  There is no real ST elevation inferiorly but there is a positive Spodik’s sign anteriorly although one could argue it also looks like there is a U-wave.

QUIZ ANSWER: What is the most likely cause of the ECG findings in this patient?

  • A) Anxiety/Panic 
  • B) Blood clot (PE) – can certainly occur with bradycardia but fits pericarditis better and D-dimer negative
  • C) Cardiac: ACS – serial trops were negative
  • D) Pericarditis – CORRECT
  • E) Electrolyte issue 

1-Minute Consult on this topic: Click HERE and scroll to proper page

Case Outcome:  CBC metabolic panel essentially normal except for bicarb of 19 with normal anion gap. Troponin normal – repeat not indicated due to duration of pain. Chest x-ray normal. CT for rule out dissection shows no neither dissection nor PE.

Patient symptoms and ECG findings most concerning for pericarditis.  Cardiology consulted and recommended discharge home with colchicine.