Pericarditis Post-Lobectomy

Report:

Sinus rhythm 98/min

Anterolateral ST segment elevation consistent with pericarditis

Possible old inferior infarction

Leads aVL and aVF are ‘reversed’ (mismounted)

Lead V1 vertically displaced.

Comment:

The pattern remained unchanged over the next few days (Fig 197a below) and there was no evidence of infarction. Post-thoracotomy pericarditis is common and almost invariably benign. This instance is somewhat unusual in that the ST elevation was confined to relatively few leads. The saddle-shaped, concave-upward elevation is typical of pericarditis.

ST depression in aVR is characteristic of pericarditis; it can also occur in V3R (as here), V1, 3 or aVL (in decreasing frequency)141. Here it’s also present in lead 3. It tends to occur in rS complexes. Below, lead V1 has it too, now that its electrode is in the right place on the chest wall (judging from the biphasic P wave).

197a. 198. Holter strips on a 64 year old lady with history of three MIs, studied for asymptomatic bradycardia. She died during the study