Case 33: A 21-Year-Old Man with Chest Pain
History
Diagnosis
ECG 2
ECG 2 Diagnosis
ECG 3
ECG 3 Diagnosis
History
A 21-year-old man is presenting to the Emergency Department with 2-day history of left anterior chest pain and worse on deep inspiration:
Diagnosis
- Sinus rhythm
- Diffuse ST elevation, PR depression
- Acute pericarditis
The patient had pain in the left lower anterior chest, with sharp increase during inspiration. A`pleuro-pericardial friction rub was heard on examination. The following ECGs show the serial changes of acute pericarditis.
ECG 2
Second ECG recorded 1 day after admission: 
ECG 2 Diagnosis
Compared with the previous tracing, negative T waves are now present in the inferior leads. Diffuse ST elevation persists.
ECG 3
Third ECG recorded 4 days after admission: 
ECG 3 Diagnosis
- The ST elevation is less marked and negative T waves are now present in I, II, III, aVF and V4-V6
- These are the typical serial changes of acute pericarditis
At this time the patient had only very mild chest pain during deep inspiration.
ECG ID: E304