Case answer #chest_pain
When the patient presents with #cardiac_symptoms and #stripe_changes and #history of recent fever. The following 4 items are at the top of the diagnoses.
#Rheumatic_fever
#Endocarditis
#Myocarditis
# Pericarditis
In rheumatic fever, the patient has migratory arthritis, nodules and rash may be observed during skin examination, and murmurs may be heard during auscultation of the heart. Exudate may be seen in the examination of the pharynx.
In endocarditis, the patient probably has risk factors such as injection drug addiction, recent dental procedures or surgery, or a history of valvular disorders. Also, #nodules or #patches may be seen during the skin examination.
In myocarditis, the patient has heart failure symptoms such as limb edema and prominent JVP
In pericarditis, the patient presents with #sharp pain. The patient’s pain is aggravated by #coughing and #deep breathing, so the patient’s breaths are shallow. The pain is aggravated by lying down and improves by bending forward. A friction murmur can be heard during heart auscultation, which is better heard during inhalation. Sometimes along with friction rub, palpable trill may also be present (especially in pericarditis caused by uremia).
In the ECG of people with pericarditis, sinus tachycardia (the most common finding) and diffuse ST elevation are observed in most of the leads, which differentiate it from STEMI:
Diffusion and upward concavity of STE
Absence of reciprocal ST depression
The decline of the PR segment in organic leads
The most common causes of STE are listed in the next post.
According to the above description and the history and examination of the patient, the diagnosis of the patient is acute pericarditis.
The cause of symptoms of heart failure (edema, shortness of breath and prominent JVP) in pericarditis can be the following:
Severe effusion and tamponade
Extensive myocardial involvement
Constrictive pericarditis
The causes of acute pericarditis are given in the following posts.
Diagnostic and therapeutic measures:
EKG whose findings were explained.
#Troponin: It is increased in 50% of cases of acute pericarditis
#Leukocytosis and increase in #CRP
If rheumatic fever is suspected, a throat culture and ASO check is performed, and if endocarditis is suspected, a blood culture is performed.
If echo is performed in acute pericarditis, pericardial effusion and evidence of various degrees of myocarditis are observed.
treatment
If there is a secondary cause, such as medical causes, myxedema, malignancy, etc., we must treat the underlying cause.
In many cases of pericarditis treatment, NSAIDs are the first line of treatment, and if the cause of pericarditis is Dressler’s syndrome, aspirin is preferable to other NSAIDs.
In order to prevent gastrointestinal complications, simultaneous administration of #PPI is also recommended.
In resistant cases, colchicine is added to NSAID, and in cases where NSAID administration is prohibited, colchicine is used alone.
#Steroids are only used in cases where there is evidence of systemic inflammatory disease, and should not be used in Dressler’s syndrome due to interference with scar formation.
In rare cases, pericardiocentesis and cardiotomy are performed.
#case_approach
#Proposal, #Dissertation #Article in
@transmed
This post is written by AlirezaaAlavii