Pericarditis, Acute

Oh, my chest

Step 1: View clinicals

A 58 year old woman presents with retrosternal chest pain for 6 hours. The pain was gradual in onset, is sharp in nature, radiates to her neck, worsens with coughing and lying down and is relieved upon learning forward. There is no associated nausea, diaphoresis or dyspnea. She was diagnosed with diabetes and hypertension 7 years ago, which are well controlled. No other co-morbidities are present. Her full blood count, ESR and renal functions are found to be normal.


Step 2: Order all relevant investigations

ECG

All leads show diffuse PR segment depressions and ST segment elevations.

D-dimers

The D-dimer assay comes as negative.

Echocardiogram

The echocardiogram shows a small pericardial effusion with no signs of cardiac tamponade. No other abnormalities are present.

Troponin-T

The troponin-T assay is weakly positive.


Step 3: Select appropriate management

NSAIDS
Thrombolysis
Anticoagulation
Pericardial aspiration


Score: ★★☆