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.
- ST must be concave/upsloping.
- STD can only be in aVR and V1.
- ST height to T height > 1 to 4.
- 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.
- 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