|Author||Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS (Reviewed by Gonzalo Romero)|
|Exam Type||USMLE Step 2 CK|
|Main Category||Internal medicine|
|Prompt||A-65-year old male presents to the ER due to a crushing retrosternal chest pain, which started 20 minutes ago. Additionally, he has nausea and diaphoresis. Following 2 hours of ER arrival, percutaneous coronary intervention is performed; he recovers over the next 5 days. 6 weeks following discharge, he returns to the office due to a mild retrosternal chest pain, which is aggravated when lying flat, and relieved when sitting up. Concomitantly, he has a mild cough and runny nose consistent with a recent upper respiratory tract infection. Complete blood count is within normal limits. What is the most likely diagnosis?|
|Answer A||Viral pericarditis|
|Answer A Explanation||Viral pericarditis is commonly caused by different virus such as: Coxsackie B, Echovirus, HIV or Adenovirus. It typically presents as an acute pericarditis with unspecific symptoms
It is important to consider the timeline of the chest pain occurring after the MI, which is 6 weeks in this case. The history of this patient is consistent with Dressler's syndrome.
|Answer B||Tuberculous pericarditis|
|Answer B Explanation||[[AnswerBExp::Tuberculous pericarditis usually presents with night sweats, weight loss and fever. Pericardial fluid with an interferon-γ level greater than 50 pg/mL is highly specific for tuberculous pericarditis. There is nothing else in the patient history to suggest a past medical history of tuberculosis.]]|
|Answer C||Post-cardiac injury pericarditis|
|Answer C Explanation||Post-cardiac injury pericarditis, also known as post-myocardial infarction pericarditis has similar clinical presentation, but it occurs 2-4 days following an MI. The pathophysiology is thought to be of autoimmune origin due to a reaction to the myocardial neo-antigens.|
|Answer D||Dressler’s syndrome|
|Answer D Explanation||[[AnswerDExp::This patient is returning to the office due to Dressler syndrome, which is a post myocardial infarction syndrome. It is a form of pericarditis that occurs in the setting of injury to the heart (myocardial infarction). Typically, it occurs 2 to 10 weeks following a myocardial infarction.]]|
|Answer E||Aortic dissection|
|Answer E Explanation||[[AnswerEExp::The history of MI suggests that myocardial infarction is the inciting factor for the pericarditis.]]|
|Explanation||[[Explanation::This patient is returning to the office due to Dressler syndrome, which is a post myocardial infarction syndrome. It is a form of fibrinous pericarditis that occurs in the setting of injury to the heart (myocardial infarction). Typically, it occurs 2 to 10 weeks following a myocardial infarction. It is usually treated with aspirin.
Educational Objective: #Dressler syndrome is a form of pericarditis that presents 2 to 10 weeks following a myocardial infarction.
Remember the causes of pericarditis using this mnemonic CARDIAC RIND, which stands for:
References: Master the Boards for Step 2 CK, 2013 edition, page 54
|Keyword||MI, Pericarditis, Chest pain, Dressler syndrome|
|Order in Linked Questions|