the case is classic for acute pericarditis
the initial ECG shows minimal ST elevation in inferior leads with Q waves
subsequent ECGS unravel acute pericarditis with diffuse ST elevation in chest leads, and lateral leads with no reciprocal changes,
there is no PR depression that is sometimes seen and points to acute pericarditis
Comments about the ECG case;
the inital presentation of the patient was atypical for ST elevation MI due to 1) relatively young age, 2) pain worse with inspiration, 3) T 38
activation of the Cath lab is reasonable with the inital ECG, if Cath lab was not available thrombolytic therapy would have been disastrous. in such a situation where Cath lab is not availabe, transfer to the nearest Cath facility is required.
in the presence of normal coronaries as mentioned, acute MI is unlikely except in the context of cocaine use which we see more of in USA, another cause of MI with normal coronaries is takstubo cardiomyopathy which can be diagnosed on Left ventricular angiogram in the Cath lab, or on echocardiogram
this is an excellent case, well done
I would also like to invite you to read some of the cases we have been writing in SAMA E-clinic
http://sama-sd.org/sama-e-clinic/case1-q1
http://sama-sd.org/sama-e-clinic/ecg-1
http://sama-sd.org/sama-e-clinic/ecg-2
http://sama-sd.org/sama-e-clinic/ecg-3
AGAIN WELL DONE AND KEEP THESE CASES COMING
Salah Abusin, MBBS, MRCP
Cardiology Fellow
Chicago, IL
USA
PS a small suggestion; delete the patient's personal information