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This post is an answer to the ECG Case 259

• Rate: 132 bpm
• Rhythm:
  • Atrial fibrillation
    • Irregular rhythm
    • Fibrillatory waves visible in leads V1-2
• Axis: Normal
• Intervals: QRS – Normal (80ms)
• Segments:
  • ST Elevation leads in I, II, aVL, aVF, V1-6
  • ST Depression in lead aVR

• Interpretation:
  • Atrial Fibrillation with rapid ventricular response
  • Diffuse ST segment elevation
• Differential Diagnosis
  • Pericarditis
  • Myocarditis
  • ACS

What happened next?

The patient had an urgent echo which showed no significant regional wall motion abnormality or pericardial effusion. He was investigated and treated for potential sepsis, malignancy, auto-immune disease and vasculitis.

Further investigation revealed an OM1 stenosis but this was not felt to be a culprit lesion. The final diagnosis was one of pneumonia with SIRS and a myo-pericarditis.

READ ALSO:

• Know the Differential for ST Segment Elevation: It’s More Than Just ACS
• Management of Atrial Fibrillation (AF) with Rapid Ventricular Response (RVR)

SIMILAR CASE: ECG Case 100: Atrial Fibrillation and Pericarditis