title: Wearing the mask of ST-elevation myocardial infarction: postpericardiotomy syndrome.
abstract: BACKGROUND
  Postpericardiotomy syndrome (PPS) is an inflammatory process, affecting 15% to 20% of patients, after surgery involving pleura, pericardium, or both. The role of electrocardiogram (ECG) in diagnosing PPS is uncertain because ECG is rarely normal (especially after cardiac surgery). We report a case of PPS that presented initially with localized ST-segment elevation and also discuss proposed mechanisms.
  
  
  METHODS
  A 60-year-old White man presented to the emergency department (ED) after having chest pain, shortness of breath, and palpitation for approximately 2 hours. Patient had known coronary artery disease, status postcoronary artery bypass graft a month earlier with a graft to right coronary artery, and 2 grafts to marginal arteries. In the ED, ECG revealed localized ST-segment elevations in leads II, III, and aVF. Coronary angiography did not reveal significant coronary artery stenosis, and all the grafts were found to be patent. Following ECG showed PR depression along with diffuse ST elevation consistent with pericarditis. Patient was started on nonsteroidal anti-inflammatory drugs and colchicine with significant improvement of his symptoms in a few days.
  
  
  CONCLUSIONS
  In our patient, injury or surgical manipulation to the area perfused by right coronary artery might have initiated a process, initially localized to the inferior wall with subsequent diffuse involvement of the entire pericardium. The presentation of our patient shortly after the development of chest pain and availability of 2 ECGs a few minutes apart may have shed light on the pathophysiology of PPS.
authors.affiliation: Department of Internal Medicine, Mercer University School of Medicine, Macon, GA. Electronic address: dr.rp17@gmail.com.
authors.forename: Rajendrakumar C
authors.initials: RC
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Mercer University School of Medicine, Macon, GA.
authors.forename: Hemant
authors.initials: H
authors.lastname: Goyal
authors.affiliation: Cardiology Division, Mercer University School of Medicine, Macon, GA.
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Shah
authors.affiliation: Cardiology Division, Mercer University School of Medicine, Macon, GA.
authors.forename: Jalal K
authors.initials: JK
authors.lastname: Ghali
mesh_terms: D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011185:Postpericardiotomy Syndrome / Q000175:diagnosis*