Following is an ECG of a 25 years old man with a four day history of left sided chest pain and its 0400 hours in the morning. He’s in a mild discomfort but looks well from the end of the bed and his observation were within normal limits. Describe the abnormalities, differential diagnosis and outline a management plan.

Interpretation:

• Rate: 66
• Rhythm: Sinus rhythm
• Axis: LAD
• Morphology:
  • 3mm STE Infr leads
  • 2mm convex STE Septolateral leads
  • STD V1
  • Pathological Q wave inferior leads
    • >1mm wide >2mm deep >25% height QRS
  • PR elevated aVR
• Intervals: Normal PR and QRS with RBBB pattern
• Summary: ?STEMI – Inferior septolateral ?myo-pericarditis ?coronary vasospasm (given age explore illicit drug use) ?-ve delta wave of WPW (given looks well and obs stable)

Clinical Closure:

• Admitted to cardiology at JHC
• Treated with aspirin / ticagrelor / heparin / analgesia
• CXR normal
• Trop 32000
• Angiogram – normal coronaries with mild focal inferior hypokinesis
• Echo – normal LV, akinesis mid inferior lateral walls, impaired systolic function EF51%, thickened infr-lateral wall (?oedema from myopericarditis), small circumferential pericardial effusion
• Rx of aspirin, Ramipril, metoprolol, ibuprofen
• F/u Echo in 2/12 – resolution of oedema, EF 57%