A 13-year-old female presented with central chest pain radiating to the left shoulder associated with sweating and one episode of syncope. ECG showed non-specific ST-T wave changes and echocardiogram found mild left ventricular systolic dysfunction, moderate mitral regurgitation, severe tricuspid regurgitation, mild pericardial effusion, and elevated cardiac markers. This supports a diagnosis of probable myopericarditis.

1. 13yr / Female
No known co-morbidties
Central chest pain , Radiating to left shoulder associated with
sweating , One episode of Syncope
ECG
ECHO - No definite RWMA , Mild LV Systolic Dysfuntion , Moderate
MR , Severe TR, Mild Pericardial Effusion , No PAH
Troponin T and CKMB - elevated

4. MI
MYOPERICARDITIS

5. MYOPERICARDITIS
Non Specific Global ST-T wave changes

8. ECG changes in Myocarditis
The most common ECG abnormalities seen in myocarditis are:
• Sinus tachycardia
• Non-specific ST segment and T waves changes
Other ECG changes are variable, and may include:
• Prolonged QRS
• QT prolongation
• Diffuse T wave inversion
• Ventricular arrhythmias
• AV conduction defects

9. ECG changes
in Pericarditis
Pericarditis is classically associated with ECG changes that evolve through four stages.
Stage 1 – widespread STE and PR depression with reciprocal changes in aVR (occurs during the first two weeks)
Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks)
Stage 3 – flattened T waves become inverted (3 to several weeks)
Stage 4 – ECG returns to normal (several weeks onwards)
Note: Less than 50% of patients progress through all four classical stages and evolution of changes may not follow
this typical pattern.

10. Summary
• This 13 year old patient admitted with above complaints of acute onset. With ECG and
ECHO changes supported with elevated Cardiac markers suggestive of Probable
myopericarditis with viral etiology.
• She initially worsened with deterioration from mild to severe LV systolic dysfunction and
respiratory distress requiring CPAP and IV inotropic support.
• Gradually recovered and tapered off inotropic and CPAP supports.
• No arrythmia documented during hospital stay.
• Patient was discharged with Steroids on tapering dose.

11. THANK YOU