A 68-year-old man was admitted with central chest pain.
He normally keeps fit and well and has no pertinent medical history. He awakened at 1 am to go to the toilet and developed sudden onset of central chest pain. He rated it at about 5 out of 10 in severity. He describes the pain as heavy and across the front of his chest but also with a more localised sharp component. There were no associated symptoms and the pain was unaffected by movement, palpation and breathing. He took two paracetamol tablets but the pain persisted for about 2 hours before his wife called 999.
What does the ECG show?
Interpretation of the ECG rhythm
Interpretation of the 12-lead ECG
He lives in a remote island location and it was not possible to undertake primary percutaneous coronary intervention (PCI). He was therefore given intravenous coronary thrombolysis (Teneceteplase). His chest pain persisted post thrombolysis and he was transferred to the nearest catheter lab for rescue PCI. However, his coronary arteries were normal.
His initial high-sensitivity troponin was negative. He developed an obvious pericardial friction rub that evening. At this time, his chest pain had become more pleuritic in nature and worsened by deep inspiration. This is a characteristic feature of pericarditis. An echocardiogram showed normal left ventricular function and a very small pericardial effusion. A diagnosis of pericarditis was made.