Slide 1: 60yo M. NSTEMI 1 week ago. Now with persistent CP and this EKG. [EKG] What’s your treatment?
Slide 2: Aspirin…because our diagnosis is: Pericarditis s/p MI.
Slide 3: Pericarditis on EKG: It’s all in the ST segment.
- Pericarditis:
- ST must be concave/upsloping.
- STD can only be in aVR and V1.
- ST height to T height > 1 to 4.
- STEMI:
- ST can be concave or convex.
- STD can be in any leads.
- ST height to T height = any ratio.
- Benign early repol:
- ST must be concave.
- Should not see STD.
- ST height to T height < 1 to 4.
- J point: fish-hook pattern in V4!
Slide 4: Today’s Pearl. Acute pericarditis + recent MI = one option. Acute anti-inflammatory treatment with high dose aspirin is the indicated treatment of choice. Thinking indomethacin? Think again! NSAIDs can impair scar formation post myocardial infarction. What about other anti-inflammatory measures? Colchicine is an effective adjunctive to anti-inflammatory medications to reduce risk of recurrent pericarditis. Steroids are reserved for patients with refractory acute pericarditis or with contraindication to anti-inflammatory treatments.
References
- Lotrionte M, et al. International collaborative systematic review of controlled clinical trials on pharmacologic treatments for acute pericarditis and its recurrences. Am Heart J. 2010 Oct;160(4):662-70. PMID 20934560
Tags: anti-inflammatory, aspirin, benign early repolarization, cardiology, colchicine, indomethacin, J point, pericarditis, post MI, ST depressions, ST elevations, ST segment, STEMI, steroids
2 comments on “60M with NSTEMI 1 week ago.”
Wasn’t ST/T radio described and validated for V6 as opposed to examples here?..
Sure, but clinical context matters and that ratio just by itself doesn’t give you all the info. Diffuse elevations in more than one coronary distribution with clinical context gives the dx. Would also advocate using colchicine up front due to reduced recurrence rate