Abstract 14064: Left Circumflex Lesion a Great Masquerader: Stemi Mimicking Classic Pericarditis

Abstract

Introduction: Pericarditis and STEMI both present with acute chest pain and ST elevations in the EKG. The pattern of ST-elevation and the nature of chest pain usually aid in clinching the diagnosis but there are exceptions. Case: 34 Y.o male with Hypertension, tobacco abuse presented with abrupt onset central chest tightness, worsening with inspiration, relieved on sitting up. EKG revealed diffuse concave ST elevation in all leads with PR depression, Posterior EKG was negative for posterior wall MI. Troponin was normal on presentation and was mildly elevated to 0.5 ng/ml 6 hours later. The echocardiogram revealed normal ejection fraction, no wall motion changes. He was being managed for acute pericarditis with colchicine and ibuprofen, 20 hours later, he experienced increased chest pain, repeat EKG was unchanged, troponin up-trended to 6 ng/ml, peaked at 20 ng/ml and was taken for an urgent angiogram. Angiogram revealed an occlusion in the mid circumflex artery and angioplasty was done. Following the procedure, the chest pain subsided. Conclusion: A classic presentation of acute pericarditis turned out to be a STEMI with circumflex as the culprit vessel. Vigilance to patient's symptoms and trending of cardiac markers are essential in identifying atypical presentations of STEMI. The circumflex lesion usually has an atypical presentation and should have a low threshold for diagnostic angiogram so as not to miss them.