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Submitted
March 5, 2019
Accepted
March 10, 2020
Published
April 30, 2020
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PDF Regional Pericarditis With Reciprocal ECG Changes Mimicking Inferior ST-Elevation Myocardial Infarction (STEMI): a Case report Regional Pericarditis With Reciprocal ECG Changes Mimicking Inferior ST-Elevation Myocardial Infarction (STEMI): a Case report
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Abstract

Acute pericarditis is generally presented with a chest pain and a diffuse ST-segment elevation in ECG. Focal ST-segment elevation due to localised inflammation of pericardium in regional pericarditis could resemble ST-elevation myocardial infarction (STEMI). A case in this study was a 30-year-old man in emergency room as a surgery resident experiencing recently acute typical chest pain. He had a history of smoking without other cardiovascular disease risk factors. ECG immediately was conducted, and it revealed ST-segment elevation in an inferior lead with reciprocal ST-segment depression in aVL, which was typical for an inferior STEMI. Primary PCI was conducted, and it surprisingly revealed a normal coronary artery. Serial serum cardiac biomarkers found a normal cardiac troponin-I level (<0.001 mcg/L) and did not significantly change after serial examinations. We treated the patient as a suspect of coronary spasm with calcium-channel blockers and nitrates. After three days of hospitalization, the patient was discharged from the hospital, and he planned to get cardiac magnetic resonance (CMR). The CMR was conducted after seven days of the discharge, and it revealed a loculated pericardial effusion leading to regional pericarditis. The patient was treated with empirical NSAIDs for three weeks. Clinical and echocardiographic evaluation after the treatment showed an excellent result. A presence of focal ST-segment elevation with reciprocal ST-segment depression was generally consistent with the STEMI, but this case was an exception. Although rare, regional pericarditis can be a differential diagnosis in a patient with acute chest pain with a focal ST-segment elevation.

Keywords

regional pericarditis reciprocal changes mimicking STEMI

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How to Cite
Rahman, G. M., & Alsagaff, M. Y. (2020). Regional pericarditis with reciprocal ECG changes mimicking inferior ST-elevation myocardial infarction (STEMI): A case report. JKKI : Jurnal Kedokteran Dan Kesehatan Indonesia, 11(1), 85–91. https://doi.org/10.20885/JKKI.Vol11.Iss1.art13
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References

  1. Snyder MJ, Bepko J, White M. Acute pericarditis: Diagnosis and management. 2014;89(7):553–60
  2. Xanthopoulos A, Skoularigis J. Diagnosis of acute pericarditis. e-Journal Cardiology Practice. 2017;15(15).
  3. Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, et al. Pericardial disease: Diagnosis and management. Mayo Clinic Proceedings. 2010;85(6):572–93.
  4. Masek KP, Levis JT. ECG diagnosis: Acute pericarditis. The Permanente Journal. 2013;17(4):e146.
  5. Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. European Heart Journal. 2015;36(42):2921–64.
  6. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2018;39(2):119–77.
  7. Bischof JE, Worrall C, Thompson P, Marti D, Smith SW. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. The American Journal of Emergency Medicine. 2016;34(2):149–54.
  8. Youssef G, Khouzam S, Sprung J, Bourke DL. Regional pericarditis mimicking myocardial infarction. Anesthesiology : Journal of the American Society of | Anesthesiology . 2001;95:261–4.
  9. Rechenmacher S, Jurewitz D, Southard J, Amsterdam E. Barking up the wrong tree: Regional pericarditis mimicking STEMI. The American Journal of Medicine. 2013;126(8):679–81.
  10. Alhammouri AT, Omar BA. Regional pericarditis mimicking inferior myocardial infarction following abdominal surgery. Case Reports in Medicine. 2014;2014:10–3.
  11. Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, et al. American society of echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: Endorsed by the society for cardiovascular magnetic resonance and society of cardiovascular computed tomography. Journal of the American Society of Echocardiography. 2013;26(9):965-1012.e15.
  12. Bogaert J, Francone M. Pericardial disease: Value of CT and MR imaging. Radiology. 2013;267(2):340–56.
  13. Dorfman TA, Aqel R. Regional pericarditis: A review of the pericardial manifestations of acute myocardial infarction. Clinical Cardiology. 2009;32(3):115–20.
  14. Daskalov IR, Valova-Ilieva T. Management of acute pericarditis: Treatment and follow-up. e-Journal Cardiology Practice. 2017;15(16).