Pericarditis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of chest pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Location is ‍retrosternalleft chest

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍sharpstabbing

Pattern ‍persistentintermittent

Worsening factors: ‍nonewith exertiondeep breathlying on the back

Alleviating factors: ‍nonerestsublingual nitroglycerinaspirinacetaminophenibuprofenNSAIDs, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍palpitations

‍shortness of breath

‍shortness of breath on exertion, ‍IIIIIIIV/IV

‍syncope

‍dizziness

‍lower extremity edema, ‍rightleftsymmetrical

‍fatigue

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diaphoresis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm



Contributing factors:

‍tobacco use

‍sedentary lifestyle

‍obesity

no history of: ‍angina, ‍myocardial infarction, ‍diabetes, ‍pulmonary embolism, ‍gastroesophageal reflux disease, ‍anxiety disorder

no family history of: ‍heart disease





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Pericarditis ‍likelysuspectedpossible

DDx: acute pericarditis, chronic pericarditis, recurrent pericarditis, pericardial effusion, constrictive pericarditis, myopericarditis, pericardial tamponade, myocarditis, acute coronary syndrome, aortic dissection, pulmonary embolism, pneumothorax, pleuritis, costochondritis, musculoskeletal pain, autoimmune diseases, uremia, neoplastic disease, radiation-induced pericarditis, post viral pericarditis, drug-induced pericarditis, trauma-related pericarditis, post-cardiac surgery pericarditis, post-myocardial infarction pericarditis





PLAN:

Investigations:

- ECG

- Chest X-ray

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍CRP, ‍ESR, ‍troponin, ‍d-dimers

- Echocardiogram

- Cardiac MRI

Treatments:

- ‍NSAIDs

- ‍Colchicine

- ‍Prednisone

- ‍PPIs

- Rest and avoid strenuous activity

Further care:

- Referral to cardiologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as chest pain, shortness of breath, or fever