Electrocardiographic diagnosis of postinfarction regional pericarditis. Ancillary observations regarding the effect of reperfusion on the rapidity and amplitude of T wave inversion after acute myocardial infarction.

Oliva, Philip B.; Hammill, Stephen C.; Edwards, William D.

doi:10.1161/01.cir.88.3.896

Cited by 58 publications

(38 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,3,4 While a rub is usually appreciated in systole, mid-diastole, and presystole, it is not always heard in all 3 phases and is transient in nature. 5,6 A total of 423 consecutive patients following myocardial infarction (MI) were evaluated for pericarditis using ECG and auscultation. Postinfarction pericarditis was diagnosed in 31 patients (7.3%) based on the presence of a pericardial rub, and of these 31 patients, only 1 had ECG changes suggestive of pericardial involvement.…”

Section: Infarct-associated Pericarditismentioning

confidence: 99%

“…6,11,12 The diagnosis of regional pericarditis remains elusive, as it is uncommon and difficult to diagnose. 6,11 Following AMI, typical ECG changes suggestive of pericarditis are rare, and several studies have reported an extremely low incidence of ST-segment elevation and PR-segment depression in this setting. 1,3 While there are no ECG criteria to diagnose infarct-associated regional pericarditis, 6 2 atypical T-waves patterns of evolution have been described with a sensitivity and specificity of 100% and 77% respectively.…”

Section: Regional Pericarditismentioning

confidence: 99%

“…6,11 Following AMI, typical ECG changes suggestive of pericarditis are rare, and several studies have reported an extremely low incidence of ST-segment elevation and PR-segment depression in this setting. 1,3 While there are no ECG criteria to diagnose infarct-associated regional pericarditis, 6 2 atypical T-waves patterns of evolution have been described with a sensitivity and specificity of 100% and 77% respectively. 6,11 In contrast to the normal pattern seen during AMI in which there are tall, peaked T-waves during the hyperacute phase that become inverted within 48 h and remain inverted for days, weeks, or even indefinitely, postinfarct regional pericarditis is associated with the following 2 atypical T-wave patterns: (1) persistently positive T-waves for 48 h after symptom onset, and (2) premature and gradual reversal of inverted T-waves to persistently upright T-waves.…”

Section: Regional Pericarditismentioning

confidence: 99%

See 2 more Smart Citations

Regional Pericarditis: A Review of the Pericardial Manifestations of Acute Myocardial Infarction

Dorfman

Aqel

2009

Clinical Cardiology

View full text Add to dashboard Cite

Regional pericarditis has been described in several settings, but occurs most frequently after transmural myocardial infarction. While the diagnosis remains elusive, it must be considered in all patients with recurrent chest pain following acute myocardial infarction (AMI). Pericarditis classically presents with positional chest pain, a pericardial friction rub, diffuse ST-segment elevation, and PR depression, but regional ECG changes associated with infarction-associated pericarditis sometimes exist. Given the magnitude and frequency of AMI, it is imperative to be aware of the myriad of pericardial manifestations of myocardial injury. An illustrative case and a comprehensive review of the literature will be provided.Key words: regional pericarditis, infarction-associated pericarditis, pericardial effusion Introduction A 53-year-old white male presented to the emergency department with severe chest pain associated with dyspnea, diaphoresis, nausea, and presyncope which was alleviated minimally by nitroglycerin and morphine. His ECG was suggestive of a posterior-lateral infarct (Figure 1), and the patient was taken emergently to the catheterization lab. Coronary angiography revealed a complete occlusion of the proximal left circumflex (LCx) coronary artery with a thrombus and TIMI 0 flow (Figure 2). Angiography was also notable for severe right coronary artery (RCA) disease (Figure 3). After clot extraction, the patient underwent successful LCx percutaneous coronary intervention (PCI) and stenting with restoration of TIMI 3 flow, and his STsegments resolved. The patient was also treated with dual anti-platelet therapy, heparin, and a glycoprotein (GP) IIbIIIa inhibitor. Cardiac enzymes peaked with a CK of 4373 U/L, a CK-MB of 283 ng/ml, and a troponin I level of 516.4 ng/ml.Within 24 h of his initial presentation, the patient began experiencing severe chest pain with recurrent ST-segment elevation in the inferior and lateral leads (Figure 4). Repeat coronary angiography was unchanged from the previous study, and the LCx stent remained patent with TIMI 3 flow ( Figure 5). The patient underwent a successful PCI of his distal RCA without resolution of his chest pain or ECG. Transthoracic echocardiography (TTE) revealed hypokinesis of the inferior and lateral walls and akinesis of the posterior walls, mild left ventricular (LV) dysfunction, and a mild-to moderate-sized pericardial effusion without evidence of tamponade physiology (Figure 6).

show abstract

Section: Infarct-associated Pericarditismentioning

confidence: 99%

Section: Regional Pericarditismentioning

confidence: 99%

Section: Regional Pericarditismentioning

confidence: 99%

See 1 more Smart Citation

Regional Pericarditis: A Review of the Pericardial Manifestations of Acute Myocardial Infarction

Dorfman

Aqel

2009

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…So far, regional pericarditis manifested as hemopericardium remained as a rare complication following large, transmural ventricular infarction [12]. Oliva and Mayo ever reported the atypical ECG natures with such regional pericarditis following MI, and so far there is no standardized ECG criteria in such clinical setting [3]. In their report of nearly 40 subjects, only 40% presented with persistent or recurrent ST segment elevation.…”

Section: Discussionmentioning

confidence: 99%

“…Regional pericarditis as an uncommon situation after MI rarely causes large effusion or clinical tamponade and is extremely difficult to be distinguished from myocardial infarction per se by traditional ECG [3]. Several prior studies had reported an extremely low incidence of typical ST-segment elevation as a typical pattern of global pericarditis [4].…”

Section: Introductionmentioning

confidence: 99%

Localized pericarditis leading to clinical tamponade with profound shock status and syncope as a major clinical manifestation after posterior wall myocardial infarction—Characterization and descriptive findings by real-time 3-dimensional echocardiography

Chi¹,

Lo²,

Hou³

et al. 2013

CRCM

View full text Add to dashboard Cite

Pericarditis and hemopericardium causing cardiac tamponade, caused by large and transmural ventricular infarction with subsequent rupture into the pericardium, is a rare complication post acute myocardial infarction. This is frequently fatal with rapid clinical course. We reported a 65-year-old female who presented with persistent diaphoresis and dyspnea for several hours followed by syncope. Acute myocardial infarction was diagnosed with primary percutaneous coronary intervention performed though persistent hypotension was observed. Moderate amount of hemopericardium leading to tamponade was found. It was relieved after pericardiocentesis. Real-time three-dimensional echocardiography revealed blood clot with specific whirling pattern around the infracted ventricular wall with suspected leak.

show abstract

Diagnostic Dilemma of Pericarditis Concurrent With ST Elevation Myocardial Infarction

2022

View full text Add to dashboard Cite

A 57-year-old man presented to the emergency department with persistent diffuse ST elevation (STE) after failed treatment with streptokinase therapy that was administered the day prior (the onset of chest pain to lytic bolus was 8 hours). The pain was persistent, radiated to the back, and was exacerbated by coughing. He had normal blood pressure (100/60 mm Hg), mild dyspnea with bibasilar rales (22 breaths per minute), elevated jugular venous pulse, and pericardial friction rub. A 12-lead electrocardiogram (ECG) was obtained (Figure , A).Question: What ECG characteristics help distinguish STE myocardial infarction (STEMI) from the simultaneous occurrence of pericarditis and STEMI?

show abstract

Electrocardiographic diagnosis of postinfarction regional pericarditis. Ancillary observations regarding the effect of reperfusion on the rapidity and amplitude of T wave inversion after acute myocardial infarction.

Cited by 58 publications

References 11 publications

Regional Pericarditis: A Review of the Pericardial Manifestations of Acute Myocardial Infarction

Regional Pericarditis: A Review of the Pericardial Manifestations of Acute Myocardial Infarction

Localized pericarditis leading to clinical tamponade with profound shock status and syncope as a major clinical manifestation after posterior wall myocardial infarction—Characterization and descriptive findings by real-time 3-dimensional echocardiography

Diagnostic Dilemma of Pericarditis Concurrent With ST Elevation Myocardial Infarction

Contact Info

Product

Resources

About