Diffusely Elevated ST Segments on Electrocardiography

Abstract

A man in his early 70s walked into the emergency department with a 4-day history of fever and tingling sensation in the chest. His medical history was significant with hypertension, intracranial hemorrhage, and chronic kidney disease (CKD). On arrival, his blood pressure was 130/64 mm Hg, heart rate was 104 beats/min, respiratory rate was 32 breaths/ min, body temperature was 37.1°C, and arterial oxygen saturation was 95% on room air. There was no murmur, rub, or gallop in chest auscultation. Electrocardiographic (ECG) findings were significant for diffuse STsegment elevation (Figure 1, A). Laboratory examination revealed leukocytosis with normal cardiac enzyme levels and mild renal dysfunction (serum creatinine, 1.4 mg/dL [to convert to micromoles per liter, multiply 88.4]). The C-reactive protein level was also elevated. He was admitted to the hospital with the suspected diagnosis of acute pericarditis. After admission, his chest discomfort resolved in 2 days, but he was still febrile, and pericardial effusion did not decrease. Computed tomography (CT) of the chest was performed (Figure 1, B and C).

Acute Aortic Dissection Masquerading as Acute Pericarditis

“…The subsequent diagnosis may therefore be incorrect or delayed in such cases ( 5 , 6 ). An accurate diagnosis in a timely manner is of remarkable importance for patients prior to developing true rupture in the pericardium resulting in tamponade, and surgical approaches are bound to be life-saving, as demonstrated in the cases reported here ( 7 , 8 ).…”