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Dan Yang: Test Results

EKG

Laboratory Results

Patient: Dan Yang
Referring Physician: Dr. Grey

CBC

wbc 5400 (5-10,000)
hct 48% (36-44% male 40-50)
polys 37% (60-80)
lymphs 63% (20-40)
Sedimentation rate 6 (0-10)

Chemistries

bun 16 mg%(18-25)
creatinine .8 mg% (5-1.7)
fasting glucose 100mg% (up to 109)
sodium 142 mmol/L (135-145)
potassium 4.0 mmol/L (3.3-4.9)
bicaronate 26 mmol/L (22-32)
chloride 101 mmol/L(97-110)

Self-assessment question:

Assuming Dan's EKG was obtained 8 hours after the onset of chest pain, what is the best explanation for the findings?

a. Acute myocardial infarction
b. Acute pericarditis
c. Ventricular aneurysm
d. Variant or Printzmetal's angina
e. Early repolarization (normal variant)

The correct answer is b, acute pericarditis. All of the above can cause ST elevation, which is the dominant finding in Dan's EKG. Pericarditis is distinguished by ST elevation in both anterior and inferior leads, and the presence of upright T-waves hours after the onset of pain. It is sometimes difficult to distinguish acute pericarditis from ischemia or infarction, especially in individuals who are at greater risk for ischemic events. In such cases, hospitalization is prudent while the diagnosis is established with serial EKG's, lab tests, and imaging.

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