Review Question - QID 107016

This patient's clinical condition is consistent with viral pericarditis, which should be treated with non-steroidal anti-inflammatory drugs, such as ibuprofen.

Although pericarditis is most commonly idiopathic, one of the most common non-idiopathic causes of this condition is a recent viral infection. Predisposing infections may be from multiple sources; however gastrointestinal and respiratory infections are most common. Patients typically present with sharp chest pain that is relieved with sitting up and leaning forward. Importantly, evaluation for the presence of pulsus paradoxus (>10 mmHg drop of systolic blood pressure with inspiration) is imperitive, as it is an important exam finding cardiac tamponade, a potentially fatal complication of acute pericarditis.

Figure A shows a typical EKG of a patient with pericarditis, with notably diffuse ST elevations and PR depressions. Illustration A shows a heart with fibrinous pericarditis, which is a common pathological finding in patients with pericarditis. This finding is thought to lead to the classic sound of the pericardial friction rub.

Incorrect Answers:
Answer 2: Aspirin is used to treat post-myocardial infarction pericarditis.
Answer 3: Steroids are used to treat lupus pericarditis.
Answer 4: Dialysis is the treatment for uremic pericarditis.
Answer 5: Pericardiocentesis is used in cases of suspected tamponade. Tamponade should be suspected in the presence of Beck's triad (hypotension, jugular venous distension, distant heart sounds) or electrical alternans.