A 14-year-old male presented to his paediatrician with no previous history of chest pain in the left anterior hemithorax radiating to the neck.
The pain started the day before, started to be mild and more severe in front of the trunk, and the patient noted that the discomfort worsened in decubitus and with deep breathing, and improved when he felt and declined.
The patient denied fever or other symptoms and had no relevant medical or surgical history.
The physical examination is completely normal; however, the pediatrician performs an electrocardiogram (ECG) and decides, in view of the test findings, to refer the patient to the hospital.
Before you continue to read, closely observe the ECG.
1.
The ECG shows sinus rhythm at 100 beats per minute.
There are no abnormalities in the P wave or in the PR segment, and the QRS complex presents an axis within the left lower quadrant (between 0 and +90o, being positive in I and aVF) without morphological changes.
So far we have not detected any data beyond normal.
Analyzing repolarization, we observed a QTc interval of normal duration, although the presence of negative T waves in leads V3-V6 is noteworthy.
We observed a marked decrease in the ST segment in V4 and somewhat lower in V5, without pathological Q waves or signs of ventricular hypertrophy.
Patient's clinical features and electrophysiological findings are established. The pediatrician diagnoses acute pericarditis and refers the patient to the hospital with very good judgment.
