SHM Converge Scientific Abstract ePoster Gallery-Covid19 Myopericarditis Mimicking St Elevation Myocardial Infarcation

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This case describes a 68-year-old man with COPD and prior lung cancer who presented with progressive dyspnea, malaise, altered mental status, and later nausea and vomiting in the setting of acute COVID-19 infection. An ECG obtained for QTc assessment showed PR depression and ST elevation in leads II, III, and aVF, and his high-sensitivity troponin exceeded 26,000, raising concern for an inferior STEMI. However, emergent left heart catheterization showed normal coronary arteries, and echocardiography demonstrated normal left ventricular function with no regional wall motion abnormalities. His ECG changes and troponin elevation were ultimately attributed to acute pericarditis, likely COVID-19-related.<br /><br />The report emphasizes that acute pericarditis is inflammation of the pericardium and is often actually myopericarditis, involving both the pericardium and myocardium. COVID-19-associated pericarditis is uncommon but clinically significant, with reported increased mortality and risk of myocardial infarction. Diagnosis of acute pericarditis requires at least two of four criteria, and ECG findings typically progress through four classic stages.<br /><br />A key teaching point is that stage 1 pericarditis can closely mimic STEMI, making clinical distinction challenging. Helpful differentiators include the overall clinical context, the morphology of ST-segment elevation, PR depression, and serial ECG evolution. In this patient, serial ECGs showed typical pericarditis progression: spreading ST elevation, T-wave flattening, T-wave inversion, and eventual normalization.<br /><br />The patient’s hypoxemic respiratory failure improved with COVID-19 treatment, and he was discharged home without oxygen.

Asset Subtitle

Nicholas Austin

Meta Tag

Author List Jared Eckman, Lorenzo Di Francesco, Nicholas Austin, Paige Harmon

Category Clinical Vignettes

Concept Acute Pericarditis

Concept ST Elevation

Concept STEMI

Concept Troponin

Concept COVID-19

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Nicholas Austin

Track Adult

Keywords

acute pericarditis

COVID-19

ST elevation

PR depression

myopericarditis

inferior STEMI mimic

troponin elevation

normal coronary arteries

ECG changes

serial ECG evolution

Acute Pericarditis

ST Elevation

STEMI

Troponin

COVID-19