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 {{WBRQuestion
|QuestionAuthor= {{M.P}}
|ExamType=USMLE Step 3
|MainCategory=Emergency Room
|SubCategory=Cardiovascular
|MainCategory=Emergency Room
|SubCategory=Cardiovascular
|MainCategory=Emergency Room
|SubCategory=Cardiovascular
|MainCategory=Emergency Room
|MainCategory=Emergency Room
|SubCategory=Cardiovascular
|MainCategory=Emergency Room
|SubCategory=Cardiovascular
|MainCategory=Emergency Room
|SubCategory=Cardiovascular
|MainCategory=Emergency Room
|SubCategory=Cardiovascular
|MainCategory=Emergency Room
|MainCategory=Emergency Room
|SubCategory=Cardiovascular
|Prompt=A 35 year old male comes to the emergency department with sudden onset of chest pain for the past 3 hours.  The pain is retrosternal without any radiation to other areas and is exacerbated by inspiration.  He is not a smoker and does not consume alcohol.  His past history is insignificant and family history is unremarkable.  On examination, his vitals are temperature 38.2 degree Celsius, pulse: 106/min, blood pressure: 130/70 mmHg and respirations: 22/min.  His pulse oximetry reading is 94 % in room air.  Cardiovascular system examination reveals a high pitched, scratchy sound at the left sternal border with regular heart sounds.  Other system examinations are normal.  An urgent electrocardiogram done reveals diffuse ST segment elevation in leads V2 to V5 with reciprocal ST depression in leads aVR and V1.   What is the most appropriate next step in the management of this patient?
|Explanation=[[Pericarditis]] is a condition in which the sac-like covering surrounding the [[heart]] (the [[pericardium]]) becomes inflamed.   Symptoms of [[pericarditis]] include [[chest pain]] which increases with deep breathing and lying flat.  Pericarditis is usually a complication of viral infections, most commonly [[echovirus]] or [[coxsackie virus]].  In addition, pericarditis can be associated with diseases such as autoimmune disorders, [[cancer]], [[hypothyroidism]], and [[kidney failure]].  Often the cause of pericarditis remains unknown, or [[idiopathic]].  A [[pericardial friction rub]] is the classic physical examination finding in pericarditis.  A careful examination must be performed to exclude the presence of [[cardiac tamponade]], characterized by the presence of [[pulsus paradoxus]], [[hypotension]], an elevated [[jugular venous pressure]], and [[peripheral edema]].  Patients with uncomplicated acute pericarditis can generally be treated and followed up in an outpatient clinic.  The treatment of viral or idiopathic pericarditis is with non-steroidal anti-inflammatory drugs.  The preferred [[NSAID]] is [[ibuprofen]] which has a large range of doses that can be titrated to the patient's tolerance.
|AnswerA=Oral ibuprofen


|AnswerAExp=[[NSAIDs]] are the mainstay in the management of uncomplicated pericarditis.  The preferred [[NSAID]] is [[ibuprofen]] which has a large range of doses that can be titrated to the patient's tolerance.
|AnswerB=High dose aspirin

|AnswerBExp=An alternative therapy is [[aspirin]] 800 mg every 6-8 hours.  In symptomatic pericarditis occurring within days after an acute [[myocardial infarction]], aspirin is preferred.
|AnswerC=Oral corticosteroids

|AnswerCExp=[[Steroids]] are not used to treat an initial episode of [[pericarditis]].  They provide rapid relief in pain, but are associated with a high rate of recurrence.
|AnswerD=Urgent cardiac catherization

|AnswerDExp=There is no evidence of myocardial ischemia or infarction in this patient.  Hence urgent cardiac catherization is not needed in this patient.
|AnswerE=Subcutaneous heparin
|AnswerEExp=Concomitant use of [[heparin]] and anticoagulant therapies is often perceived as a possible risk factor for the development of a worsening or hemorrhagic [[pericardial effusion]] that may result in [[cardiac tamponade]].  Hence heparin should be avoided whenever possible in these patients. 
|EducationalObjectives=[[NSAIDs]] are the mainstay in the management of uncomplicated pericarditis.  
|RightAnswer=A
|WBRKeyword=[[Pericarditis]]
|Approved=Yes
}}