Answer to #FridayImageChallenge

Well done! The answer to our #FridayImage was Myopericarditis.

We picked this case to discuss a differential for ST elevation on ECG. From a great NEJM paper from 2003 (ST-segment elevation in conditions other than acute myocardial infarction. Wang K, Asinger RW, Marriott HJ)

screenshot-2016-09-13-12-49-40

And then! What’s the difference between….

Myocarditis: inflammation of the heart muscle
Pericarditis: the inflammation of the lining outside the heart.
Myopericarditis: elevated troponin in the setting of pericarditis without new onset of focal or diffuse depressed LV function by echo or MRI
Perimyocarditis: with new onset of focal or diffused depressed LV function

Remember: Acute pericarditis: dx by the presence of 2 or more: chest pain, pericardial friction rub, ECG changes (diffuse ST-segment elevation or PR depression) and pericardial effusion.

Typical ECG: initially diffuse ST elevation and PR depression, followed by normalization of ST and PR segments, and then diffuse T-wave inversions