Chapter 24 Pericarditis

Question 1

How does the patient with pericarditis present?

Answer 1

Retro sternal chest pain worsened with inspiration and relieved by leaning forward. One day history of sharp chest pain, history of flu like illness a week ago and fever

Question 2

What is the differential diagnoses for chest pain?

Answer 2

Gerd, pneumonia, pulmonary embolism, musculoskeletal pain, acute myocardial infraction

Question 3

Should emergency orders be done? Why?

Answer 3

Yes because chest pain can always be life-threatening; EKG, cardiac monitoring, oxygen therapy IV access pulse oximetry BP monitoring

Question 4

What does present on the ECG for Pericarditis?

Answer 4

Diffuse ST segment elevation.

Question 5

What are the possible underlying acute pericarditis causes?

Answer 5

Viral agents, neoplasm, uremia, autoimmune, tuberculosis, bacteria, mayocardio infarction, trauma (cardiac surgery)

Question 6

What diagnostic study should be done for this patient?

Answer 6

CBC for infection or inflammation BMP for uremia ESR, chest x-ray and echocardiogram for cardiac Tamponade, cardiac enzymes, blood cultures in febrile patients. Tuberculin skin test, ANA, HIV serology

Question 7

This patient has lymphocytosis elevated ESR and normal troponin was elevated CK, what is the diagnosis? Should they be admitted, why?

Answer 7

Idiopathic Pericarditis; Yes due to the fever

Question 8

What is the criteria for pericarditis patients to be hospitalized?

Answer 8

Fever greater than 100.4, cardiac Tampanade , failure to respond to NSAIDs within a week, immunocompromised, anticoagulated, acute trauma, elevated cardiac troponin

Question 9

What is the treatment for viral or idiopathic Pericarditis?

Answer 9

NSAIDs while symptomatic usually less than two weeks, treat with Colchicine for three months

Question 10

We should be avoided if patient is post MI pericarditis?

Answer 10

NSAIDs except for aspirin

Question 11

What should be used in idiopathic or viral pericarditis patients that are resistant to NSAIDs and Cochicine?

Answer 11

Steroids

Question 12

What should we use in autoimmune Pericarditis?

Answer 12

Steroids

Question 13

Which pericarditis necessitates treating the etiology in order to treat the condition?

Answer 13

Hemodialysis for uremia

Question 14

What are the diagnostic test that can be ran but it’s not obligatory?

Answer 14

D dimer, pericardiocentesis, pericardial fluid analysis, viral culture or serology

Question 15

What counseling should be done for this patient

Answer 15

Counsel patient, reassurance

Question 16

What should be monitored and this patient for follow up

Answer 16

CBC BP monitoring cardiac monitoring and ESR

Question 17

What is the location course for this patient?

Answer 17

ER, the ward, then home