A 35 yo with sharp chest pain

​A 35 yo patient presents with sharp central chest pain, that he has had since yesterday and has become worst.
The pain does not radiate and improves when he sits up.
He has no other symptoms and no other medical history.
Examination is essentially normal.
His ECG is shown below;

What does the ECG show?

ANSWER

There are changes consistent with pericarditis. (MEMBERS Login and go to the section on PERICARDITIS)
There is widespread ST elevation, with the ST elevation in III being less than in II
​There is also PR depression and no reciprocal changes, although there is T wave inversion in aVL.

The patients troponin returns and is 8000ng/L.

Which of the following would you do in this 35 yo?:
(a) Activate the Cath lab, or if you don't have one transfer to a Cath lab equiped hospital
(b) Thrombolyse if no Cath lab
(c)  Get an ECHO
(d) Do a serial Troponin

Is there a difference between Myopericarditis and Perimyocarditis?
The answer is YES there is.
​Myopericarditis has a good prognosis and no left ventricular involvement.

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