WBR1125

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Emergency Room
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 35 year old male comes to the emergency department with sudden onset of chest pain for the past 3 hours. The pain is retrosternal without any radiation to other areas and is exacerbated by inspiration. He is not a smoker and does not consume alcohol. His past history is insignificant and family history is unremarkable. On examination, his vitals are temperature 38.2 degree Celsius, pulse: 106/min, blood pressure: 130/70 mmHg and respirations: 22/min. His pulse oximetry reading is 94 % in room air. Cardiovascular system examination reveals a high pitched, scratchy sound at the left sternal border with regular heart sounds. Other system examinations are normal. An urgent electrocardiogram done reveals diffuse ST segment elevation in leads V2 to V5 with reciprocal ST depression in leads aVR and V1. What is the most appropriate next step in the management of this patient?]]
Answer A	AnswerA::Oral ibuprofen
Answer A Explanation	[[AnswerAExp::NSAIDs are the mainstay in the management of uncomplicated pericarditis. The preferred NSAID is ibuprofen which has a large range of doses that can be titrated to the patient's tolerance.]]
Answer B	AnswerB::High dose aspirin
Answer B Explanation	[[AnswerBExp::An alternative therapy is aspirin 800 mg every 6-8 hours. In symptomatic pericarditis occurring within days after an acute myocardial infarction, aspirin is preferred.]]
Answer C	AnswerC::Oral corticosteroids
Answer C Explanation	[[AnswerCExp::Steroids are not used to treat an initial episode of pericarditis. They provide rapid relief in pain, but are associated with a high rate of recurrence.]]
Answer D	AnswerD::Urgent cardiac catherization
Answer D Explanation	AnswerDExp::There is no evidence of myocardial ischemia or infarction in this patient. Hence urgent cardiac catherization is not needed in this patient.
Answer E	AnswerE::Subcutaneous heparin
Answer E Explanation	[[AnswerEExp::Concomitant use of heparin and anticoagulant therapies is often perceived as a possible risk factor for the development of a worsening or hemorrhagic pericardial effusion that may result in cardiac tamponade. Hence heparin should be avoided whenever possible in these patients.]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::Pericarditis is a condition in which the sac-like covering surrounding the heart (the pericardium) becomes inflamed. Symptoms of pericarditis include chest pain which increases with deep breathing and lying flat. Pericarditis is usually a complication of viral infections, most commonly echovirus or coxsackie virus. In addition, pericarditis can be associated with diseases such as autoimmune disorders, cancer, hypothyroidism, and kidney failure. Often the cause of pericarditis remains unknown, or idiopathic. A pericardial friction rub is the classic physical examination finding in pericarditis. A careful examination must be performed to exclude the presence of cardiac tamponade, characterized by the presence of pulsus paradoxus, hypotension, an elevated jugular venous pressure, and peripheral edema. Patients with uncomplicated acute pericarditis can generally be treated and followed up in an outpatient clinic. The treatment of viral or idiopathic pericarditis is with non-steroidal anti-inflammatory drugs. The preferred NSAID is ibuprofen which has a large range of doses that can be titrated to the patient's tolerance. Educational Objective: NSAIDs are the mainstay in the management of uncomplicated pericarditis. References: ]]
Approved	Approved::Yes
Keyword	[[WBRKeyword::Pericarditis]]
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::