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Patient
Young man 21 years of age with no previous history or cardiovascular risk factor, hospitalized for severe, violent chest pain, increased by inspiration accompanied by a 38° fever; cardiac enzymes are not increased, CRP of 135; cardiac ultrasound with no segmental kinetic disorders with pericardial effusion of medium abundance;
Trace
This tracing shows a sinus rhythm, a PQ segment depression mainly in leads I, II with an elevation in aVR; absence of significant Q-waves; diffuse ST-segment elevation (present in leads I, II, aVL, V3-V6) concave upward in its initial aspect followed by positive T-waves; ST-segment depression in aVR and V1; alternans pattern in the amplitude of the QRS-complexes clearly visible in limb leads;
Exergue
As with an acute coronary syndrome, pericarditis can lead to chest pain with ST-segment elevation. Some electrocardiographic elements are suggestive of pericarditis: depression of the associated PQ segment, absence of necrosis Q-waves, elevation pattern differing from ACS (diffuse, not corresponding to a defined coronary territory, concave upwards in its initial portion), absence of reciprocity except in aVR and V1.
The clinical history and the electrocardiogram of this patient are highly evocative of the diagnosis of viral acute pericarditis. Treatment including rest and high-dose anti-inflammatory medication quickly relieved symptoms and normalized the electrical appearance within a few weeks.