Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Administer aspirin
0%
0/0
Administer clopidogrel
Administer prednisone
Perform emergent cardiac catheterization
Perform pericardiocentesis
Select Answer to see Preferred Response
This patient with pleuritic chest pain and EKG changes consistent with acute pericarditis in the setting of recent myocarditis likely has peri-infarction pericarditis (PIP). PIP is thought to develop due to inflammation as a result of transmural myocardial infarction (MI). Typically it presents 2-3 days after MI. Notably, it should be differentiated from Dressler syndrome, which is an autoimmune pericarditis that typically develops weeks-months after MI. Pericarditis classically presents with symptoms of dyspnea, cough, fever, and pleuritic chest pain. Physical exam findings include pericardial friction rub, elevated JVP, and pulses paradoxus. Electrocardiogram typically demonstrates diffuse ST segment elevation not restricted to a single coronary artery distribution, as well as PR segment depression. PIP is usually managed with high dose aspirin administration. NSAIDs other than aspirin and steroids are typically avoided as they may impair collagen deposition and increase the risk of post-MI complications. Most patients improve over the course of several days.Verma et. al review pericarditis related to myocardial infarction. They distinguish peri-infarction pericarditis from Dressler syndrome. They advise avoidance of NSAIDs and steroids, and recommend management with aspirin.Figure A shows characteristic ECG changes in acute pericarditis.Incorrect Answers:Answer 2: Clopidogrel, or another anti-platelet agent such as ticagrelor was likely already administered to this patient due to their recent myocardial infarction. Clopidogrel would not address the underlying peri-infarction pericarditisAnswer 3: Prednisone may be appropriate for management of Dressler syndrome, which develops weeks to months after MI. Prednisone is avoided for PIP due to impairment in collagen deposition.Answer 4: Cardiac catheterization may be appropriate for a subsequent MI. However, this patient's history and ECG points toward pericarditis as a more likely diagnosis.Answer 5: Pericardiocentesis is indicated in patients with cardiac tamponade who are hemodynamically unstable. This patient with normal vital signs has no evidence of tamponade physiology.Bullet Summary: Peri-infarction pericarditis presents several days after myocardial infarction and is managed with administration of aspirin.
4.8
(8)
Please Login to add comment