Pericarditis and myocarditis are characterised by electrocardiographic changes and elevated cardiac enzymes, respectively, and patients with perimyocarditis often complain of chest discomfort. These findings are nonspecific and often lead to diagnostic difficulties, as ST-elevation myocardial infarction commonly presents in a similar fashion. Clinical differentiation between perimyocarditis and myocardial infarction are especially important because adverse side effects can occur if reperfusion therapy is administered for a patient with acute pericarditis or if a diagnosis of acute myocardial infarction is missed. We herein describe a case of perimyocarditis with ST elevation and raised cardiac markers, which led to two emergency coronary angiographies that were subsequently found to be normal. We include the three serial electrocardiographies (ECGs) performed to show the characteristic features of perimyocarditis and further discuss the importance of identifying typical and atypical ECG features of pericarditis.
L e t t e r t o t h e E d i t o r 305Dear Sir, I would like to thank Chhabra and Chaubey (1) for their astute comments on our article. They pointed out Spodick's sign, which comprises PR segment depression and downsloping TP segments, as a diagnostic electrocardiographic marker to help distinguish acute pericarditis from acute coronary syndrome.(2) This is very important, as pericarditis accounts for 5% of emergency department visits for chest pain without myocardial infarction, (3) and recognising such subtle electrocardiographic features may enable prompt treatment of acute pericarditis. Our patient's electrocardiogram showed Spodick's sign following a one-day prodrome of febrile illness, which is in contrast to that of another case report, where Spodick's sign appeared a little after the onset of acute pericarditis.(4) The cause for discrepancy in the time of onset is unclear.Chhabra and Chaubey also raised important differential diagnoses of variant-form (regional) takotsubo cardiomyopathy and coronary vasospasm. Both differentials may demonstrate electrocardiographic findings of ST elevation and regional wall motion abnormalities on echocardiography. Our patient's clinical condition improved following hospital discharge and she was not keen on further cardiac imaging. We agree that cardiac magnetic resonance imaging would be particularly useful for our patient.Yours sincerely,
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