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Tuesday, 17 July 2012

Percarditis - a specific cause of ST elevation


Pericarditis
Pericarditis is a cause of ST elevation which often throws us.

If faced with uncertainty, in patients who are not unwell enough to warrant admission, and in whom the chest pain history does not suggest an acute coronary syndrome, then the most helpful test to support the ECG, is a serum CRP (rarely normal in pericarditis).

These patients are often younger, with a lingering history of onset of symptoms, and frequently present to GP. (Some are inevitably admitted via the paramedic 999 service, having presented with chest pains and an abnormal ECG).

Typical ECG of Pericarditis :

Key Points:

  • ST segment elevation is widespread across multiple leads (not localised as in STEMIs) and there is no reciprocal ST segment depression
  • Scooped or saddle-shaped ST segments, Often notched.
  • Associated PR segment depression (usually elevated in aVR).

Symptoms:
Often associated with viral prodrome – such as a bad cold with aching joints. (inflammatory markers raised)
Longer-lasting symptoms than acute MI.
Pain can be eased sitting forward, and may be worse when laying back.

Examination/Ix
Sometimes associated rub ("footsteps in the snow")
CRP usually significantly raised (normal CRP pretty much excludes pericarditis)
ECHO may reveal small pericardial Effusion.




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