26 Sep Carlys Post: Based on the presenting symptoms and
Carlys Post: Based on the presenting symptoms and physical findings, the most likely diagnosis would be acute pericarditis. This acute inflammation of the pericardium is “most often idiopathic (autoimmune) or caused by viral infection” (McCance & Huether, 2019). The diagnosis is based on the patient exhibiting the hallmark symptoms of acute pericarditis, in addition to the upper respiratory infection that he had two weeks prior. The pericardium is the double-layered sac that surrounds the heart. Pericarditis causes sharp chest pain due to the irritated layers of the pericardium rubbing against each other. The layers rubbing together can be heard upon auscultation, indicating pericardial friction rub. With acute pericarditis, the “chest pain is abrupt in onset, pleuritic, and substernal or left precordial in location. It may radiate to the trapezius ridge, neck, arms, or jaw. The pain is relieved by leaning forward and worsens when lying supine” (Tingle, Molina, & Calvert, 2007). Given his age, it is unlikely that this patient is experiencing a myocardial infarction (MI). It is not impossible but the symptoms exhibited by the patient are indicative of acute pericarditis. “Acute pericarditis has a number of potential etiologies including infection, acute MI, medication use, trauma to the thoracic cavity, and systemic diseases, such as rheumatoid arthritis. However, most etiologic evaluations are inconclusive” (Snyder, 2014). The patient should have an ECG to confirm the diagnosis. It would be expected that there would be ST segment elevation in addition to PR segment depression. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the treatment of choice for acute pericarditis. Colchicine, another anti-inflammatory drug, would be prescribed if symptoms are severe or last more than two weeks. Corticosteroids may be prescribed of symptoms are recurrent, and antibiotics may be prescribed if a bacterial infection is the underlying cause. References McCance, K. & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Elsevier. Snyder, M., Bepko, J., & White, M. (2014). Acute pericarditis: Diagnosis and management. American Family Physician, 89(7), 553-560. Tingle, L., Molina, D., & Calvert, C. (2007). Acute pericarditis. American Family Physician, 76(10), 1509
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