WBR0030

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Author Raviteja Reddy Guddeti MBBS, Aarti Narayan MBBS
Exam Type USMLE Step 3
Main Category Emergency Room
Sub Category Cardiovascular
Prompt A 65 year old male initially presents to the ER with crushing, retrosternal chest pain aswell as nausea and diaphoresis for more than 20 minutes of duration. Percutaneous coronary intervention was performed within 2 hours of arrival to the ER. The patient recovered over the next few days. The patient presented to the doctors office 6 weeks after being discharged, with a mild, retrosternal chest pain that was aggravated by a supine position, and relieved by leaning forward. He also has a mild cough and runny nose consistent with recent upper respiratory tract infection. Complete blood count was normal. What is the most likely diagnosis?
Answer A Acute pericarditis
Answer A Explanation The history of this patient is more consistent with Dressler's syndrome. There is nothing else in the patient history to suggest a different form of pericarditis.
Answer B Tuberculous pericarditis
Answer B Explanation The history of this patient is more consistent with Dressler's syndrome. There is nothing else in the patient history to suggest a different form of pericarditis, and no 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 presents the same clinical picture, except that it occurs within the first 2-4 days following an MI.The pathophysiology is thought to be of autoimmune origin, which is a reaction to myocardial neo-antigens.
Answer D Dressler’s syndrome
Answer D Explanation Dressler's syndrome is the correct answer.
Answer E Idiopathic
Answer E Explanation The history of MI suggests that myocardial infarction is the inciting factor for the pericarditis, and it is not idiopathic.
Right Answer D
Explanation The correct answer is Dressler’s syndrome. Dressler's syndrome or post myocardial infarction syndrome is a form of pericarditis that occurs in the setting of injury to the heart as a result of myocardial infarction. Dressler's syndrome typically occurs 2 to 10 weeks after the myocardial infarction occurs.

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