WBR0431

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Cardiology
Prompt	[[Prompt::A 63-year-old man presents to the emergency department with severe chest pain and dyspnea. Following rapid work-up, the diagnosis of myocardial infarction (MI) is made. The patient undergoes appropriate management and is then discharged home. The patient returns 5 weeks later to the emergency department with complaints of a new-onset, low-grade fever associated with persistent chest pain that radiates to the back and relieved by leaning forward. Cardiac auscultation is remarkable for friction rub. Which of the following pathological processes is responsible for this patient’s rehospitalization?]]
Answer A	AnswerA::Increased left ventricular (LV) preload due to left ventricular failure post-MI
Answer A Explanation	AnswerAExp::LV failure is a common complication post-MI, but the symptoms and signs of this patient do not suggest LV failure.
Answer B	AnswerB::Ventricular free wall rupture with subsequent fluid accumulation in the pericardial sac
Answer B Explanation	[[AnswerBExp::Ventricular free wall rupture and subsequent cardiac tamponade are life-threatening emergencies. Manifestations of cardiac tamponade include dyspnea, chest pain, hypotension, jugular venous distension, pulsus paradoxus, and faint heart sounds upon auscultation.]]
Answer C	AnswerC::New-onset cardiac arrhythmia that abolishes the atrial kick
Answer C Explanation	AnswerCExp::Cardiac arrhythmias are common post-MI complications, but the patient's signs and symptoms are not suggestive of cardiac arrhythmias.
Answer D	AnswerD::Autoimmune process that causes fibrinous pericarditis
Answer D Explanation	AnswerDExp::Dressler syndrome is an autoimmune process that causes fibrinous pericarditis.
Answer E	AnswerE::Post-procedural stent thrombosis
Answer E Explanation	AnswerEExp::Post-procedural stent thrombosis is a complication of percutaneous interventions (PCI). The patient's symptoms and signs are strongly suggestive of a pericardial disease rather than a coronary disease.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Dressler syndrome (post-myocardial infarction syndrome) is an autoimmune fibrinous pericarditis that occurs 4-6 weeks following a myocardial infarction (MI) (typically large infarct size in the anterior region). It is characterized by delayed onset of symptoms post-MI, presence of antiheart antibodies, change in cellular immunity, high recurrence rate, and rapid response to anti-inflammatory agents, all of which confirm the autoimmune nature of the disease. Dressler syndrome manifests with low-grade fever and characteristic pericarditis-induced chest pain that is classically described as chest pain that radiates to the back and relieved by leaning forward. On physical examination, patients typically have signs of pericarditis (pericardial friction rub). Dressler syndrome is typically managed with administration of aspirin. Dressler syndrome is distinguished from other forms of post-MI pericarditis (epistenocardiac pericarditis) by its autoimmune nature, association with more severe symptoms, significant elevations in ESR, and delayed onset post-MI. Educational Objective: Dressler syndrome is an autoimmune fibrinous pericarditis that typically occurs 4-6 weeks following a myocardial infarction. References: Spodick DH. Decreased recognition of the post-myocardial infarction (Dressler) syndrome in the postinfarct setting: Does it masquerade as "idiopathic pericarditis" following silent infarcts? Chest. 2004;126(5):1410-1. First Aid 2014 page 288, 289, 293]]
Approved	Approved::No
Keyword	WBRKeyword::Dressler syndrome, WBRKeyword::Myocardial infarction, WBRKeyword::Pericarditis, WBRKeyword::Chest pain, WBRKeyword::Autoimmune disease, WBRKeyword::Fibrinous pericaraditis, WBRKeyword::Complication, WBRKeyword::Post-myocardial infarction syndrome
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::