Country cardiograms case 17

Rudy E. Gasparelli, MD, CCFP

CJRM 2000;5(3):149.

A 38-year-old man presented to the hospital emergency department at 01:00 hours complaining of chest heaviness. This had started in the afternoon after an argument with his foreman. The chest tightness had been intermittent since then, and each episode had lasted about 5 minutes. He had been told 10 years previously, and again in 1997, that he had pericarditis. He had had a stress EKG
and stress echocardiogram about 18 months prior to this admission to hospital and had been told that the test results were normal. His blood pressure at the time of presentation was 180/120; he was a nonsmoker with no history of diabetes or high cholesterol. His maternal grandmother had heart disease when in her 60s.

The 12-lead EKG is shown here (Fig. 1). Fortunately, we had a previous EKG on file for comparison; it was the same.

• Do you think the EKG supports a diagnosis of myocardial infarction?
• What do you think of the previous diagnosis of pericarditis?

"Country cardiograms" is a regular feature of the Canadian Journal of Rural Medicine. In each issue we will present an electrocardiogram and discuss the case in a rural context. Please submit cases to Ms Suzanne Kingsmill, Canadian Journal of Rural Medicine, Box 1086, Shawville QC JOX 2Y0.

© 2000 Society of Rural Physicians of Canada