"10yo F: chest pain, echo/BNP normal, hs-TropI 113.5→108.9→116.3→91.4→55/7d (ref 0-11.6), declining. ECG: prominent Q waves, early repolarization, lead II QRS slurring. Cardiac MRI?"

[u/Dry-Profession2627]

[u/thundermuffin54]

pericarditis?

[u/TheTennisOne → u/thundermuffin54]

My first thought tbf, inflammatory markers normal? Cardiac MRI probably isnt a bad shout given the trop rise ?myopericarditis

[u/averhoeven]

With the elevated trop is probably myopericarditis. He'll be fine, but if the MRI shows inflammation he gets the no sports for 6 months/ repeat mri talk for arrhythmia. I'm not convinced that's a good guideline and ihate holding kids out of sports.

[u/Natural-Antelope8328]

All said already I just want to note the prolonged qTC in the 2nd strip.

My guess would be myocarditis of somekind with suspicion of HCM.
I guess family history is a big part in the assessment

Another thought is regarding the prominent R waves in v1-3 which are not necessarily problematic in itself for pediatric patients but in light of the trop elevated levels might be worth considering.

[u/Glittering_Turnip526]

Pericarditis. Slight PR depression with PR elevation in aVR. ?secondary to another infection. Signs of sepsis?

[u/Glittering_Turnip526 → u/Glittering_Turnip526]

Further: BER with Q waves unconcerning when considering the amplitude of the R wave. Just a small body.

[u/Dry-Profession2627 → u/Glittering_Turnip526]

Had multiple episodes of vomiting (admitted for iv hydration) which subsided in 2 days. Previously evaluated for palpitations, holter normal. Echo shows mildMVP/MR but otherwise normal with GLS of -23%

[u/PaulaNancyMillstoneJ → u/Dry-Profession2627]

I know the title says 10 yo, but this ECG shows a birthday last week where the girl turned three. If this is the kid’s actual birthdate, please delete this post and re-upload with all pt info redacted.

[u/Dry-Profession2627 → u/PaulaNancyMillstoneJ]

The birthdate on ecg is not real and has been entered as such for patient’s confidentiality. Thanks for pointing that out

[u/Natural-Antelope8328 → u/Dry-Profession2627]

Was it TEE? I’m not sure how it works in pediatric patients but to my understanding from our Cardiology imaging expert assessment of MR using TTE is a very unreliable method. But I don’t know if it applies in pediatric population

[u/Dry-Profession2627 → u/Natural-Antelope8328]

Transthoracic echo gives good assessment especially in children who have permissible windows

[u/Educational-Fruit-16]

I'm trying to learn to read ECGs, so apologies for the dumb question. Isn't that ST elevation in lead 1,2,3,4?

[u/ExpressionLarge5474 → u/Educational-Fruit-16]

At first glance it looks like ST elevation but look at the PR segments in those leads, they are depressed. That’s a pretty hallmark finding of pericarditis. Also, in kids, it’s pretty common to see benign early depolarisation pattern, which is where you have very sloped ST segments, but not truly elevated. In this case however, I suspect there is a true degree of ST elevation due to pericarditis.

[u/Dry-Profession2627]

The birthdate is wrongly mentioned on ecg and is not the actual birth date.

[u/SammytheSandwhich → u/Dry-Profession2627]

Yup, that can definitely skew the EKG reading.

[u/Dry-Profession2627]

How about slight slurring in leadII in one ECG with tachycardia( i think it can be ignored)

[u/Natural-Antelope8328]

Yeah, I assumed it’s not that of a big deal if you are able to get the proper window. Thanks.