Take-home ECG pearls from Yerem:
- HR trend for SVT: when evaluating patients for SVT, remember to use the heart rate trend on telemetry to see how the tachycardia started. If the HR gradually accelerated over time, this is more suggestive of something like sinus tachycardia. If the HR suddenly jumps from a normal HR to a tachycardic rate, it is more suggestive of other things on the ddx like AVNRT, AVRT, a-flutter.
- ECG vessel territories: when Yerem looks at an ECG, he thinks about things in coronary territories. If you see ST elevations in multiple of these territories, it is more likely pericarditis and it would be hard to invoke a clot as the cause. Here are the territories:
- Precordial leads: LAD (anterior wall)
- II, III, aVF: right coronary (inferior wall)
- I, aVL: circumflex, maybe high diag or OM branch (lateral wall)
- aVR: the “big daddy” that is a sign of global ischemia like a L main lesion
Treatment of pericarditis:
- Most patients should be treated with combination colchicine + NSAIDs (rather than NSAIDs alone)
- There is decreased recurrence with this and reduces symptoms! It used to be NSAIDs alone but this has shifted with more recent RCT’s and systematic reviews
- Check out the ICAP trial from 2013
- If the patient has an MI and pericarditis, the recommendation is to use ASA (high dose) + colchicine since NSAIDs affect healing/scarring of the heart
Chest pain in a young person: this is always a helpful differential to review. Check out this previous post!