• J Emerg Med · Feb 2024

    Case Reports

    The Heart Has its Reasons Which Reason Knows Not: A Curious Case of Chest Pain.

    • Michael Wallace, Nick Schoenmann, and Stanton Royer.
    • Department of Emergency Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia.
    • J Emerg Med. 2024 Feb 1; 66 (2): 229231229-231.

    BackgroundElectrocardiographic (ECG) findings of T-wave inversions in V1-V3, with or without accompanying epsilon waves, often raise concerns for the rare, but potentially lethal, arrhythmogenic right ventricular cardiomyopathy (ARVC). However, this pattern may be found in pericardial agenesis, an even rarer pathology. Concomitant myocarditis can confuse this presentation further.Case ReportWe report a case of a previously healthy man who presented with left-sided chest pain, ECG findings suggestive of ARVC, and a final diagnosis of myocarditis with underlying partial pericardial agenesis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A growing number of cases have reported pericardial agenesis demonstrating ECG changes similar to ARVC. We discuss an approach to a diagnostically challenging patient. This case emphasizes the importance of a broad differential and the danger of premature closure.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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