Case 8

Thanks to Mark Santamaria for this case 

Stem: This 35 year old male presented with a 6 hour history of severe left sided chest pain that radiated to the neck,  and was associated with sweating and shortness of breath.

+ List the significant findings in the ECG and provide the most likely or important diagnosis

  • The rhythm is regular. There is a sinus tachycardia with a rate of about 115 beats per minute. The PR, QRS and QT intervals are within normal limits
  • The frontal plane QRS axis is normal. The transition zone is in Lead V4
  • There is slight (1-2 mm) J point elevation in Leads V2 to V6. The T waves are upright in these leads, with a broad base and a upward stroke having a slightly concave contour.
  • PR segment elevation is present in Lead aVR, and PR segment depression is seen in Lead II, and in Leads aVF and V3 to V5
  • These changes are consistent with acute pericarditis

Notes:

  1. The isoelectric line is stable in this case, making it easy to see the PR segment depression