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Author Aarti Narayan MBBS, Raviteja Reddy Guddeti MBBS
Exam Type USMLE Step 3
Main Category Emergency Room
Sub Category Allergy/Immunology, Cardiovascular
Prompt A 75-year-old male presents to the ER with chest pain of 20 minutes duration. His EKG shows ST-elevation in the anterior precordial leads, and laboratory studies show an elevation of cardiac enzymes. The patient is found to have 3 vessel disease on coronary angiography. Immediate CABG is performed and the patient recovers post-surgery. He is discharged in stable condition. The patient presents again to the ER two weeks later, this time complaining of severe retrosternal chest pain that radiates to the back. On further inquiry, he mentions that his pain is aggravated by lying down and alleviated by sitting up and leaning forward. What is the most probable diagnosis?
Answer A Dressler’s syndrome
Answer A Explanation [[AnswerAExp::Incorrect: Dressler's syndrome is a form of pericarditis that occurs secondary to injury to the heart, most commonly as a result of myocardial infarction. Dressler's syndrome typically occurs 2 to 10 weeks after myocardial infarction.]]
Answer B Post-myocardial infarction pericarditis
Answer B Explanation Incorrect:Post-myocardial infarction pericarditis, much like Dressler's syndrome, is a pericarditis which occurs after a myocardial infarction. However Dressler's syndrome will occur 2-10 weeks after an MI, whereas post-myocardial infarction pericarditis typically occurs 2-4 days after a myocardial infarction.
Answer C Post-pericardiotomy syndrome
Answer C Explanation Correct: Post-pericardiotomy syndrome is the correct answer.
Answer D Pulmonary embolism
Answer D Explanation Incorrect: Pulmonary embolism refers to the blockage of the pulmonary vasculature by a substance from elsewhere in the body, most commonly a blood clot. Pulmonary embolism is associated with sudden onset chest pain, tachycardia, and shortness of breath. Risk factors for pulmonary embolism include immobility, a past thromboembolic event, and any other causes of hypercoagulable state.
Answer E Idiopathic
Answer E Explanation Incorrect: The history of the patient suggests that cardiac surgery is the inciting factor for the pericarditis in this case.
Right Answer C
Explanation [[Explanation::The correct answer is post-pericardiotomy syndrome. The post-pericardiotomy syndrome is inflammation of the pericardium (the sac surrounding the heart) that occurs following cardiac surgery. Symptoms can occur from days to weeks after the operation. The syndrome is thought to have an autoimmune basis.

Educational Objective: Post-pericardiotomy syndrome is characterized by inflammation of the pericardium following cardiac surgery.

References: Postpericardiotomy syndrome
Educational Objective:
References: ]]

Approved Yes
Keyword Pericarditis, Myocardial, MI, Myocardial infarction, CABG, Chest pain, Chest
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