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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=Aarti Narayan MBBS, Raviteja Reddy Guddeti MBBS
|QuestionAuthor=Aarti Narayan MBBS, Raviteja Reddy Guddeti MBBS (Reviewed by Gonzalo Romero)
|ExamType=USMLE Step 2 CK
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|MainCategory=Internal medicine
Line 20: Line 20:
|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 treatment of choice for this patient?
|Prompt=A-52-year old female undergoes percutaneous coronary intervention at a local community hospital.  5 weeks following discharge, she presents to her primary care physician complaining of sharp retrosternal chest pain, aggravated when lying flat and inspiration, and relieved when sitting up.  What is the treatment of choice of the most likely diagnosis?
|Explanation=The treatment of choice is high dose enteric coated Aspirin. Acetaminophen may be added for pain management.
|Explanation=This patient is returning to the office due to [[Dressler's syndrome]], which is a post myocardial infarction syndrome. It is a form of fibrinous pericarditis that occurs in the setting of injury to the heart (myocardial infarction). Typically, it occurs 2 to 10 weeks following a myocardial infarction. This differentiates Dressler's syndrome from the much more common post myocardial infarction pericarditis that occurs in 17 to 25% of cases of acute myocardial infarction between days 2 and 4 after the myocardial infarction. Dressler's syndrome also needs to be differentiated from pulmonary embolism, another identifiable cause of pleuritic (and non-pleuritic) chest pain in people who have been hospitalized and/or undergone surgical procedures within the preceding weeks.
It is believed to result from an autoimmune inflammatory reaction to myocardial neo-antigens.
 
The treatment of choice is high dose enteric coated [[Aspirin]]. Acetaminophen may be added for pain management.
|AnswerA=Corticosteroids
|AnswerA=Corticosteroids
|AnswerAExp=Corticosteroids are not the treatment of choice in Dressler's syndrome.
|AnswerAExp=Corticosteroids are not the treatment of choice in Dressler's syndrome.  Glucocorticoids and nonsteroidal antiinflammatory drugs are potentially harmful for treatment of pericarditis after STEMI.
|AnswerB=Aspirin
|AnswerB=Aspirin
|AnswerBExp=This is the correct answer.
|AnswerBExp=Is the treatment of choice to treat Dressler's syndrome.
|AnswerC=Morphine
|AnswerC=Morphine
|AnswerCExp=Morphine is not the treatment of choice in Dressler's syndrome.
|AnswerCExp=Administration of acetaminophen, colchicine, or narcotic analgesics may be reasonable if aspirin, even in higher doses, is not effective.
|AnswerD=Cyclophosphamide
|AnswerD=Colchicine
|AnswerDExp=Cyclophosphamide is not the treatment of choice in Dressler's syndrome.
|AnswerDExp=Administration of acetaminophen, colchicine, or narcotic analgesics may be reasonable if aspirin, even in higher doses, is not effective.
|AnswerE=Rest
|AnswerE=Rest
|AnswerEExp=Rest alone will not treat Dressler's syndrome.
|AnswerEExp=Rest alone will not treat Dressler's syndrome. Pharmacological therapy with aspirin is the recommended drug of choice.
|EducationalObjectives=Dressler's syndrome is a form of pericarditis that presents 2 to 10 weeks following a myocardial infarction.
The treatment of choice is high dose enteric coded aspirin.
|References=O'Gara PT, Kushner FG, Ascheim DD, et al. (December 2012). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=MI, Pericarditis, Aspirin, NSAIDs, Dressler's syndrome
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 19:55, 15 March 2014
Author PageAuthor::Aarti Narayan MBBS, Raviteja Reddy Guddeti MBBS (Reviewed by Gonzalo Romero)
Exam Type ExamType::USMLE Step 2 CK
Main Category MainCategory::Internal medicine
Sub Category SubCategory::Cardiovascular
Prompt [[Prompt::A-52-year old female undergoes percutaneous coronary intervention at a local community hospital. 5 weeks following discharge, she presents to her primary care physician complaining of sharp retrosternal chest pain, aggravated when lying flat and inspiration, and relieved when sitting up. What is the treatment of choice of the most likely diagnosis?]]
Answer A AnswerA::Corticosteroids
Answer A Explanation AnswerAExp::Corticosteroids are not the treatment of choice in Dressler's syndrome. Glucocorticoids and nonsteroidal antiinflammatory drugs are potentially harmful for treatment of pericarditis after STEMI.
Answer B AnswerB::Aspirin
Answer B Explanation AnswerBExp::Is the treatment of choice to treat Dressler's syndrome.
Answer C AnswerC::Morphine
Answer C Explanation AnswerCExp::Administration of acetaminophen, colchicine, or narcotic analgesics may be reasonable if aspirin, even in higher doses, is not effective.
Answer D AnswerD::Colchicine
Answer D Explanation AnswerDExp::Administration of acetaminophen, colchicine, or narcotic analgesics may be reasonable if aspirin, even in higher doses, is not effective.
Answer E AnswerE::Rest
Answer E Explanation AnswerEExp::Rest alone will not treat Dressler's syndrome. Pharmacological therapy with aspirin is the recommended drug of choice.
Right Answer RightAnswer::B
Explanation [[Explanation::This patient is returning to the office due to Dressler's syndrome, which is a post myocardial infarction syndrome. It is a form of fibrinous pericarditis that occurs in the setting of injury to the heart (myocardial infarction). Typically, it occurs 2 to 10 weeks following a myocardial infarction. This differentiates Dressler's syndrome from the much more common post myocardial infarction pericarditis that occurs in 17 to 25% of cases of acute myocardial infarction between days 2 and 4 after the myocardial infarction. Dressler's syndrome also needs to be differentiated from pulmonary embolism, another identifiable cause of pleuritic (and non-pleuritic) chest pain in people who have been hospitalized and/or undergone surgical procedures within the preceding weeks.

It is believed to result from an autoimmune inflammatory reaction to myocardial neo-antigens.

The treatment of choice is high dose enteric coated Aspirin. Acetaminophen may be added for pain management.
Educational Objective: Dressler's syndrome is a form of pericarditis that presents 2 to 10 weeks following a myocardial infarction. The treatment of choice is high dose enteric coded aspirin.
References: O'Gara PT, Kushner FG, Ascheim DD, et al. (December 2012). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology]]

Approved Approved::Yes
Keyword WBRKeyword::MI, WBRKeyword::Pericarditis, WBRKeyword::Aspirin, WBRKeyword::NSAIDs, WBRKeyword::Dressler's syndrome
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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