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Patient case: Acute pericarditis

Discussion

A 40-year-old female from a rural area in sub-Saharan Africa presents to the clinic with a 5-day history of sharp, pleuritic chest pain that worsens when she lies down and improves when sitting forward. She also reports feeling fatigued and having low-grade fever and difficulty breathing. The pain radiates to her left shoulder and is associated with a dry cough. She has no significant past medical history but mentions a recent upper respiratory tract infection with mild sore throat and cough about 1-2 weeks ago.

On physical examination, the patient is febrile with a temperature of 38.2°C (100.8°F), and her heart rate is elevated at 110 beats per minute. Blood pressure is 110/70 mmHg. Auscultation of the heart reveals a characteristic pericardial friction rub. Lung examination is clear, with no signs of consolidation. The rest of the physical examination is unremarkable. An ECG shows widespread ST-segment elevations and PR depression in multiple leads. Laboratory tests show mild elevation in inflammatory markers (CRP and ESR), and a chest X-ray is unremarkable.

Given the patient's history of recent viral illness, characteristic chest pain, pericardial friction rub, and ECG findings, she is diagnosed with acute pericarditis. She is started on nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation and is advised to follow up regularly to monitor for any complications.

Questions
1. What is the most likely diagnosis for this patient based on her symptoms and ECG findings?

A) Acute myocardial infarction

B) Acute pericarditis

C) Pulmonary embolism

D) Aortic dissection

2. Which of the following physical examination findings is most suggestive of acute pericarditis?

A) S3 gallop

B) Pericardial friction rub

C) Jugular venous distension

D) Murmur of mitral regurgitation

3. What is the most likely cause of this patient's acute pericarditis?

A) Bacterial infection

B) Recent viral illness

C) Autoimmune disorder

D) Trauma

 

4. What is the most appropriate initial treatment for this patient with acute pericarditis?

A) Anticoagulation therapy

B) Antibiotics

C) Nonsteroidal anti-inflammatory drugs (NSAIDs)

D) Steroids

 

Reveal answers

Answers

  1. B) Acute pericarditis
  2. B) Pericardial friction rub
  3. B) Recent viral illness
  4. C) Nonsteroidal anti-inflammatory drugs (NSAIDs)

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