Teenager Presenting With Chest Pain and ST-Segment Changes on Electrocardiogram After SARS-CoV-2 Illness: Early Repolarization vs. Acute Pericarditis

Abstract

The ST-segment elevation is commonly associated with acute myocardial Infarction. However, there are other non-ischemic causes of ST-elevation. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly contagious illness that continues to plague the world since the first case was reported in China over two years ago. As cases of the diseases become rampant, we have learned more of its complications which can include cardiac and pericardial disease. We present a case report of a young African American male who presented with chest pain six weeks after being diagnosed with SARS-Cov-2 pneumonia. Electrocardiogram (EKG) showed ST-segment changes that were initially presumed to be acute pericarditis. The patient was initially treated with colchicine. After further workup and a second opinion, ST-segment changes were thought to be likely benign early repolarization changes rather than pericarditis. Differential diagnosis of ST-segment changes on EKG in the patient with chest pain is broad. Subtle findings on EKG are important in distinguishing these differentials and should be well known and understood.

A Case of Pure Pericarditis Associated With COVID-19: Application of Classical Clinical Evaluation for Differential Diagnosis

“…An excellent case report in 2022 by Amoateng et al [ 16 ] detailed the evaluation of a 19-year-old man with chest pain who had recovered from COVID pneumonia just six weeks prior to his presentation. The patient presented with some clinical features consistent with pericarditis and an EKG with changes suspicious for pericarditis but more consistent with early repolarization.…”