Acute Pericarditis: The Daily PANCE Blueprint

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Acute Pericarditis: The Daily PANCE Blueprint

A 28-year-old man presents with 2 days of sharp, pleuritic chest pain that is worse lying flat and improves when he leans forward, one week after a viral upper respiratory illness. A scratchy friction rub is heard at the left sternal border. ECG shows diffuse concave ST-segment elevation with PR-segment depression. Troponin is mildly elevated; bedside echo is normal with no effusion. Which of the following is the most likely diagnosis?

A. ST-elevation myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Acute pericarditis
E. Cardiac tamponade

Answer and topic summary

The answer is D. Acute pericarditis

Pleuritic, positional chest pain relieved by sitting forward + a pericardial friction rub + diffuse ST elevation with PR depression is classic acute pericarditis (usually post-viral). The mild troponin reflects myopericarditis. STEMI gives regional ST elevation with reciprocal change; tamponade gives Beck triad + pulsus paradoxus with an effusion (echo here is normal). First-line treatment is NSAIDs + colchicine.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Traumatic, infectious, and inflammatory heart conditions ⇒ Acute pericarditis

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