August 02, 2010

MRCP 2 Question 17

Most likely diagnosis:

a) pulmonary embolism
b) early repolarization
c) acute pericarditis
d) acute myocardial infarction
e) Myocarditis

The correct answer is B


One must be able to distinguish acute pericarditis from normal early repolarization. This pattern is most common in teenage boys and men in their 20s.

These individuals differ from pericarditis patients in that the clinical syndrome of pain and dyspnea is absent, PR-segment depression is present in some patients but uncommon, and, most important, the ECG does not, over time, evolve a pattern of return of the ST segment to baseline followed by T-wave inversion

Image above shows single electrocardiographic complexes comparing (left) acute pericarditis, (center) early repolarization and (right) injury pattern of acute myocardial infarction. Note the degree of ST-segment elevation is greater in the pericarditis complex than in the early repolarization complex.

Important findings of acute infarction include the presence of Q waves and a more convex upward ST segment, both of which are present in the right complex.

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