Diagnostic and treatment dilemma when pericarditis mimics acute myocardial infarction and vice versa in the era of early thrombolytic therapy

It is difficult to differentiate the electrocardiographic signs of acute pericarditis from those of acute myocardial infarction. This problem has plagued many doctors who are faced with decisions regarding the initiation of thrombolytic therapy. Thrombolytic therapy is the standard of treatment in acute myocardial infarction where 'time is muscle.' On the other hand, inadvertent administration of thrombolytic therapy in a patient with acute pericarditis may be deleterious. We present two such cases, where the electrocardiogram of acute pericarditis mimics acute myocardial infarction and vice versa. We recommend early transthoracic echocardiography in such situations, looking for wall-motion abnormalities or evidence of pericardial effusion. In situations where the transthoracic echocardiogram is not helpful, and if coronary artery disease is suspected, early cardiac catheterization is indicated.