Regional Pericarditis with Reciprocal ECG Changes Mimicking Inferior STEMI

Author : G. M. Rahman, M.Y. Alsagaff
Upload Date : 19-04-2018

Background: Acute pericarditis is generally presented with typical diffuse ST-T changes in Electrocardiogram (ECG). The presence of focal pattern of  ST-T abnormality with reciprocal ECG changes is pathognomonic for ST-Elevation Myocardial Infarction (STEMI) and being used to differentiate it with pericarditis. Regional Pericarditis, through rare, presents further challenge related to a paucity of published diagnostic criteria.

Case: A 30-year-old man on duty in ER as a surgery recident with the presentation of recent acute typical chest pain. He had history of smoking with no other CVD risk factor. ECG examination immadietely performed and revealed ST-segment elevation in inferior lead with reciprocal changes in aVL. Primary PCI was performed and surprisingly revealed a normal coronary arteries. Serial serum cardiac biomarkers examined and revealed slight increase of the CKMB. The patient began conservative therapy with Calcium-Channel Blockers and Nitrates. After 3 days of hospitalization patient discharges from the hospital planned to perform CMRI. CMRI was performed 3 days after discharge and revealed “Loculated Pericarditis and Pericardial Effusion”. The patients was treated with empirical Non-Steroidal Antiinflamatory Drugs (NSAIDs) for 6 Month. Clinical and Echocardiographic evaluation was performed after treatment and revealed preserved LV function with no sequele of the past illness.

Conclusion: We have reported an exceptional case of Regional Pericarditis presented with focal pattern of ST elevation with patognomonic reciprocal ECG changes which mimicking STEMI.

KEYWORDS : Regional – Pericarditis – Reciprocal – Changes – Mimicking - STEMI

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