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LETTER TO EDITOR
Year : 2015  |  Volume : 7  |  Issue : 1  |  Page : 32

Regional pericardits: A mischievous masquerader


1 Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
2 Department of Cardiovascular Medicine, Hartford Hospital, Connecticut, USA
3 Department of Cardiology, Saint Vincent Hospital, Worcester, Massachusetts, USA

Date of Web Publication27-Jan-2015

Correspondence Address:
Vinod K Chaubey
Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1947-2714.150093

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How to cite this article:
Chaubey VK, Chhabra L, Kaur NJ, Spodick DH. Regional pericardits: A mischievous masquerader. North Am J Med Sci 2015;7:32

How to cite this URL:
Chaubey VK, Chhabra L, Kaur NJ, Spodick DH. Regional pericardits: A mischievous masquerader. North Am J Med Sci [serial online] 2015 [cited 2019 Nov 19];7:32. Available from: http://www.najms.org/text.asp?2015/7/1/32/150093

Dear Editor,

We read with great interest the work by Orme et al. published in recent issue of the North American Journal of Medicine and Science. [1] They highlight an interesting concept of electro cardiogram (ECG) manifestation in regional pericarditis.

Indeed, regional pericarditis is a valid consideration given a recent history of ablation procedure. However, a few alternate diagnostic considerations would be of value such as transient coronary vasospasm especially given the reciprocal ST-depressions in the inferior leads. Serial ECG monitoring and information on temporal resolution (not provided in the case illustration) would be of great value for the diagnostic confirmation. Temporal ECG changes often add a diagnostic value especially in challenging cases (temporal T-wave inversions simultaneous to the ST-elevations often support myocardial ischemia as opposed to pericarditis). Atypical progression of T wave viz. persistently positive T-waves for 48 h after symptom onset, and premature and gradual reversal of inverted T-waves to persistently upright T-waves, is 100% sensitive and 77% specific for regional pericarditis. [2],[3]

Again, if the vasospasm is excluded as a diagnostic consideration, the ST-depressions in the inferior leads and positive troponin strongly suggest a trans-mural inflammatory process suggestive of regional peri-myocarditis as opposed to pericarditis alone. [4]

Though regional pericarditis is certainly a challenging diagnosis, we want to emphasize that the presence of pericardial rub is a diagnostic hallmark for regional epistenocardiac pericarditis. [5] For the obvious value of correct clinical diagnosis, a careful serial examination in these cases is often helpful since pericardial rub may often be transient. [6] Nonetheless, the cardiac magnetic resonance imaging (MRI) would have been the gold standard confirmatory modality in the presented case. [7]

 
  References Top

1.
Orme J, Eddin M, Loli A. Regional pericarditis status post cardiac ablation: A case report. N Am J Med Sci 2014;6:481-3.  Back to cited text no. 1
    
2.
Dorfman TA, Aqel R. Regional pericarditis: A review of the pericardial manifestations of acute myocardial infarction. Clin Cardiol 2009;32:115-20.  Back to cited text no. 2
    
3.
Oliva PB, Hammill SC, Edwards WD. Electrocardiographic diagnosis of postinfarction regional pericarditis. Ancillary observations regarding the effect of reperfusion on the rapidity and amplitude of T wave inversion after acute myocardial infarction. Circulation 1993;88:896-904.  Back to cited text no. 3
    
4.
Chhabra L, Chaubey VK, Spodick DH. A case of seasonal recurrent myopericarditis? Tough to say! J Am Osteopath Assoc 2014;114:532.  Back to cited text no. 4
    
5.
Spodick DH. The pericardium: A comprehensive textbook. 1 st ed. Volume 1. New York: Marcel Dekker; 1997.  Back to cited text no. 5
    
6.
Chhabra L, Spodick DH. Pericardial disease in the elderly. In: Aronow WS, Fleg JL, Rich MW, editors. Cardiovascular Disease in the Elderly. 5 th ed. Volume 1. London, UK: CRC Press; 2013. pp. 644-68.  Back to cited text no. 6
    
7.
Doulaptsis C, Goetschalckx K, Masci PG, Florian A, Janssens S, Bogaert J. Assessment of early post-infarction pericardial injury by CMR. JACC Cardiovasc Imaging 2013;6:411-3.  Back to cited text no. 7
    



This article has been cited by
1 Takotsubo cardiomyopathy associated with perimyocarditis: yet another important differential diagnosis to entertain
L Chhabra,VK Chaubey
Singapore Medical Journal. 2015; 56(05): 304
[Pubmed] | [DOI]



 

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