Case 53: An 81-Year-Old Man with Chest Pain
History
Diagnosis
ECG 2
ECG 2 Diagnosis
ECG 3
ECG 3 Diagnosis
History
This 81-year-old man came to the Emergency Department complaining of anterior chest pain of 4 days duration, worse when sitting up and inhaling deeply. For several months, his state of health had deteriorated, with increasing weakness and weight loss:
Diagnosis
- Sinus tachycardia, 104/min
- Probably left atrial enlargement
- PR depression
- Marked diffuse ST elevation – acute pericarditis
Investigations showed no evidence of myocardial infarction. The echocardiogram demonstrated well-preserved ventricular function and a small-to-moderate pericardial effusion. A careful search for malignancies was negative, but moderately severe renal insufficiency was noted.
ECG 2
The following ECG was recorded two days after admission. His chest pain had markedly decreased:
ECG 2 Diagnosis
- Coarse atrial fibrillation with rapid ventricular response (105/min)
- Compared with the previous tracing, the diffuse ST elevation is less marked
ECG 3
Two weeks after admission, the following ECG was recorded. The patient’s condition had improved; his chest pain had resolved, and he was able to walk slowly without discomfort:
ECG 3 Diagnosis
- Sinus rhythm, 100/min
- Possible left atrial enlargement
- Mild ST elevation in the chest leads
- T wave inversion in most leads
ECG ID: E601