A 14yo boy presents with fever and chest pain for 2 days. The chest pain is pleuritic and worse with leaning back. On examination, lung sounds are clear bilaterally, heart is regular with no murmurs, but a friction rub is heard. Which of the following is true of this condition?
A. Treatment of choice is NSAID therapy
B. All patients must be admitted to the hospital on a cardiac monitor
C. CXR is always abnormal
D. Electrocardiogram most commonly shows ST elevation isolated to leads II, III, and aVF
E. Pain is rarely referred to shoulder or back
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April 3, 2017 at 12:47 pm
A. The patient is presenting with pericarditis. Fever, dyspnea, and chest pain are the classic triad of symptoms, and chest pain is often worse with deep breaths, leaning back, and improved by sitting up and leaning forward; pain may be referred to the shoulder, back, or epigastrium. EKG typically shows diffuse ST elevation, but may also just show nonspecific T wave flattening. CXR is usually normal but may show cardiomegaly if there is a large effusion (rare). Bedside US will often demonstrate pericardial fluid. The majority of patients will spontaneously recover over 1-2 weeks, and routine admission is not necessary in stable patients with little to no effusion, normal troponin, no significant leukocytosis or high fever.