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|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|SubCategory=Cardiovascular
|Prompt=A 65 year old male initially presents to the ER with crushing, retrosternal chest pain aswell as nausea and diaphoresis for more than 20 minutes of duration. Percutaneous coronary intervention was performed within 2 hours of arrival to the ER. The patient recovered over the next few days. The patient presented to the doctors office 6 weeks after being discharged, with a mild, retrosternal chest pain that was aggravated by a supine position, and relieved by leaning forward. He also has a mild cough and runny nose consistent with recent upper respiratory tract infection. Complete blood count was normal. What is the most likely diagnosis?
|Prompt=A-65-year old male presents to the ER due to a crushing retrosternal chest pain, which started 20 minutes ago.  Additionally, he has nausea and diaphoresis. Following 2 hours of ER arrival, percutaneous coronary intervention is performed; he recovers over the next days. 6 weeks following discharge, he returns to the office due to a mild retrosternal chest pain, aggravated by supine position, and relieved by leaning forward. He also has a mild cough and runny nose consistent with a recent upper respiratory tract infection. Complete blood count is within normal limits. What is the most likely diagnosis?
|Explanation=The correct answer is Dressler’s syndrome. Dressler's syndrome or post myocardial infarction syndrome is a form of pericarditis that occurs in the setting of injury to the heart as a result of myocardial infarction. Dressler's syndrome typically occurs 2 to 10 weeks after the myocardial infarction occurs.
|Explanation=This patient is returning to the office due to [[Dressler syndrome]], which is a post myocardial infarction syndrome.  It is a form of pericarditis that occurs in the setting of injury to the heart (myocardial infarction). Typically occurs 2 to 10 weeks after the myocardial infarction.
|AnswerA=Acute pericarditis
* [[Acute pericarditis]] presents between 6 weeks to 6 months of the disease onset.  Acute pericarditis is more common than chronic pericarditis, and often occurs as a complication of viral infections, immunologic conditions, or as a result of a heart attack(myocardial infarction).  
|AnswerAExp=The history of this patient is more consistent with Dressler's syndrome. There is nothing else in the patient history to suggest a different form of pericarditis.
* Subacute pericarditis presents within 6 weeks to 6 months of the disease onset
|AnswerB=Tuberculous pericarditis
* Chronic pericarditis manifests after 6 months of the disease onset. Chronic pericarditis is less common. It may manifest as scarring of the pericardium, which is a condition known as constrictive pericarditis.
|AnswerBExp=The history of this patient is more consistent with Dressler's syndrome. There is nothing else in the patient history to suggest a different form of pericarditis, and no past medical history of tuberculosis.
'''Educational Objective:''' 
<br>References: Master the Boards for Step 2CK
|AnswerA=Viral pericarditis
|AnswerAExp=The history of this patient is more consistent with Dressler's syndrome. It is important to consider the timeline of the chest pain occurring after the MI, which is 6 weeks in this case.  Viral pericarditis caused by different virus, commonlyCoxsackie B virus, Echovirus, HIV and Adenovirus.
Influenza|AnswerB=Tuberculous pericarditis
|AnswerBExp=The history of this patient is more consistent with Dressler's syndrome. There is nothing else in the patient history to suggest a different form of pericarditis, and no past medical history of [[tuberculosis]].
|AnswerC=Post-cardiac injury pericarditis
|AnswerC=Post-cardiac injury pericarditis
|AnswerCExp=Post-cardiac injury pericarditis, also known as post-myocardial infarction pericarditis presents the same clinical picture, except that it occurs within the first 2-4 days following an MI.The pathophysiology is thought to be of autoimmune origin, which is a reaction to myocardial neo-antigens.
|AnswerCExp=Post-cardiac injury pericarditis, also known as post-myocardial infarction pericarditis has similar clinical presentation, but it occurs 2-4 days following an MI. The pathophysiology is thought to be of autoimmune origin due to a reaction to the myocardial neo-antigens.
|AnswerD=Dressler’s syndrome
|AnswerD=Dressler’s syndrome
|AnswerDExp=Dressler's syndrome is the correct answer.
|AnswerDExp=Dressler's syndrome is the correct answer.
|AnswerE=Idiopathic
|AnswerE=Idiopathic
|AnswerEExp=The history of MI suggests that myocardial infarction is the inciting factor for the pericarditis, and it is not idiopathic.
|AnswerEExp=The history of MI suggests that [[myocardial infarction]] is the inciting factor for the pericarditis, and it is not idiopathic.
|RightAnswer=D
|RightAnswer=D
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 06:00, 24 February 2014
Author PageAuthor::Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS
Exam Type ExamType::USMLE Step 2 CK
Main Category MainCategory::Internal medicine
Sub Category SubCategory::Cardiovascular
Prompt [[Prompt::A-65-year old male presents to the ER due to a crushing retrosternal chest pain, which started 20 minutes ago. Additionally, he has nausea and diaphoresis. Following 2 hours of ER arrival, percutaneous coronary intervention is performed; he recovers over the next days. 6 weeks following discharge, he returns to the office due to a mild retrosternal chest pain, aggravated by supine position, and relieved by leaning forward. He also has a mild cough and runny nose consistent with a recent upper respiratory tract infection. Complete blood count is within normal limits. What is the most likely diagnosis?]]
Answer A AnswerA::Viral pericarditis
Answer A Explanation [[AnswerAExp::The history of this patient is more consistent with Dressler's syndrome. It is important to consider the timeline of the chest pain occurring after the MI, which is 6 weeks in this case. Viral pericarditis caused by different virus, commonlyCoxsackie B virus, Echovirus, HIV and Adenovirus.

Influenza]]

Answer B AnswerB::Tuberculous pericarditis
Answer B Explanation [[AnswerBExp::The history of this patient is more consistent with Dressler's syndrome. There is nothing else in the patient history to suggest a different form of pericarditis, and no past medical history of tuberculosis.]]
Answer C AnswerC::Post-cardiac injury pericarditis
Answer C Explanation [[AnswerCExp::Post-cardiac injury pericarditis, also known as post-myocardial infarction pericarditis has similar clinical presentation, but it occurs 2-4 days following an MI. The pathophysiology is thought to be of autoimmune origin due to a reaction to the myocardial neo-antigens.]]
Answer D AnswerD::Dressler’s syndrome
Answer D Explanation AnswerDExp::Dressler's syndrome is the correct answer.
Answer E AnswerE::Idiopathic
Answer E Explanation [[AnswerEExp::The history of MI suggests that myocardial infarction is the inciting factor for the pericarditis, and it is not idiopathic.]]
Right Answer RightAnswer::D
Explanation [[Explanation::This patient is returning to the office due to Dressler syndrome, which is a post myocardial infarction syndrome. It is a form of pericarditis that occurs in the setting of injury to the heart (myocardial infarction). Typically occurs 2 to 10 weeks after the myocardial infarction.
  • Acute pericarditis presents between 6 weeks to 6 months of the disease onset. Acute pericarditis is more common than chronic pericarditis, and often occurs as a complication of viral infections, immunologic conditions, or as a result of a heart attack(myocardial infarction).
  • Subacute pericarditis presents within 6 weeks to 6 months of the disease onset
  • Chronic pericarditis manifests after 6 months of the disease onset. Chronic pericarditis is less common. It may manifest as scarring of the pericardium, which is a condition known as constrictive pericarditis.

Educational Objective:
References: Master the Boards for Step 2CK
Educational Objective:
References: ]]

Approved Approved::Yes
Keyword
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