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ECG education

Central sharp chest pain: what is the diagnosis?

Vivienne Miller

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Abstract

Based on the history and ECG results, a series of questions are answered about the diagnosis of a woman with central sharp chest pain radiating into her neck.

Key Points

  • Patients with pericarditis may or may not have a viral prodrome. The most common viral symptoms are adenoviral – sore throat, headache and gastrointestinal tract symptoms.
  • The nature of the pain is often useful in the diagnosis, especially if it is better leaning forward.
  • The severe pain can resolve with analgesia very quickly, but the ECG changes can persist.
  • Recurrence is possible but uncommon and more often seen in connective tissue disease.
  • There may be an effusion on echocardiogram and it can be large.
  • Effusion is uncommon and if it is significant it may need drainage. Pericardial constriction can occur late, so this should be kept in mind
  • It is not uncommon to find a mildly elevated troponin level, probably due to some associated mild myocarditis.
  • These patients usually do not have LV impairment, although it can occur.

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