1. CASE HISTORY (Chest Pain)
By Dr. Zahoor

2. A 32 year old male comes to the emergency department with acute chest pain. There is previous history of occasional chest pain lasting for a second since last 2 years. The current pain had come 4 hours earlier and has been persistent since then. Pain is central and radiates to both sides of chest. It is not associated with shortness of breath. The pain is relieved by sitting up and leaning forward.

3. Two weeks ago, he had upper respiratory infection, sore throat, blocked nose, sneezing and cough which lasted for four days. In family history, his father had MI at the age of 51 years and was found to have slightly high cholesterol level. He is non-smoker and drinks 15 unit of alcohol per week.

4. Examination
Pulse – 75/minute
Blood Pressure – 124/75mmHg
Temperature – 37.8oC
Investigations
Cholesterol 5.1mmol/L (desirable range 5.5mmol/L)
Chest X-ray – normal
Hemoglobin, WBC – normal
CK – slightly raised
ECG – see on next slide

5. ECG

6. Questions:
What is the diagnosis?
Should thrombolysis be given?

7. Answers: 1. Viral pericarditis ECG is showing ST segment elevation which is concave upward, it is characteristic of pericarditis 2. No