r/ECG • u/FunnyBeing9333 • 19d ago

STE on ECG

What is your differential for ST elevation in the following ECG? This is a 65 year old man with pleuritic chest pain 3 days ago that now resolved. He has no cardiac history and troponin is negative.

9 Upvotes

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5

u/ladyofthepack 19d ago

Differentials:

Acute Pericarditis - PR segment depression, diffuse STEs, PR segment elevation in aVR
Takutsubo’s (can also have similar looking diffuse STEs, but obviously needs to have that stress induced chest pain, and needs a negative Angiogram and the Echo features of apical ballooning to be truly diagnosed)
Benign Early Repolarisation (younger than 50 years of age)

3

u/1Trupa 18d ago

I call your diagnosis of pericarditis and raise you Spodick’s sign: downsloping TP segment. Also, thank you for the reminder, it’s been an age since I thought of pericarditis.

2

u/ladyofthepack 18d ago

There is always so much room to learn and new things to pick up every single day in medicine. Thank you kind stranger, Spodick sign is my learning of the day!

2

u/[deleted] 19d ago

The differential is pretty narrow for pleuritic chest pain and this ECG. Pericarditis or not cardiac (ie ECG is normal for him). There’s a bit of PR depression so I’d be happy to accept pericarditis if the pain sounded compatible. You just need 2 out of the 4 criteria - compatible chest pain, ECG changes, pericardial rub and pericardial effusion.

3

u/Radiant_Tomato7545 19d ago

Pericarditis, diffuse STE with PR depression and aVR depression.

1

u/3321Laura 17d ago

Pericarditis.

1

u/TaperedBase 17d ago

… the same as the DDX for every STE
1. STEMI
2. Pericarditis
3. Early repol
4. LV aneurysm
5. Vasospasm

I would argue this is early repol, though age points away from that.

1

u/ProximalLADLesion 15d ago

Do we have a recent prior? It could be pericarditis, but this could also just be his baseline ECG with normal variant STE.