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A patient presents with severe chest pain, anxiety, and malaise. The physician suspects that it could be pericarditis. Which diagnostic procedure would help distinguish the cause as pericarditis?
a. ABG
b. ECG
c. Heart sounds
d. X-ray -
- True or false. Pericarditis is the most commonly suspected diagnosis for patients experiencing chest pain.
a. True
b.False - When examining a patient with pericarditis, a pericardial friction rub is detected. What distinguishes a pericardial friction rub from a pleural friction rub?
a. A pericardial friction rub is a palpable vibration on the anterior chest wall that is in tandem with the apical pulse.
b. A pleural friction rub only appears upon inspiration when the thoracic cavity expands.
c. A pericardial friction rub can still be detected with the cessation of breathing.
d. A pleural friction rub can only be detected laterally. - A patient is having difficulty understanding the complications of additional fluid surround the heart. They report that “having extra fluid means extra protection around their heart”. What information would be best used to educate the patient on their condition?
a. The sack of fluid is pooling blood that needs to go into circulation.
b. More fluid surrounding the heart allows for less blood to fill the heart to be pumped out leading to poor circulation.
c. The bacteria in the pericardial sack are being pumped out throughout the body and need to be eliminated.
d. The sack will compress the lungs, leading to less expansion, causing shortness of breath. - A patient presents to the ER with complaints of anterior left sternal chest pain. The patient also reports that they had taken two sublingual nitroglycerin tablets which did not relieve the symptoms as in the past. Upon examination a pericardial rub is heard in the heart with inspiration, expiration but not while holding their breath. The patient has been in the ER several times due to heart attacks in the past and notes that he has a “elevation just like before” upon looking at the ECG. What information could be used to inform the patient that he most likely did not suffer a STEMI, and what further investigation should be completed?
a. Nitro was unsuccessful to relieve chest pain and analyze ECG for PR depression and ST elevation to rule out pericarditis against a pulmonary embolism.
b. Explain that a negative troponin in the blood means that there was no heart attack. The elevation they are referring to is a TP segment, which confirms pericarditis.
c. Explain that because the rub is not heard while holding breath, the heart is fine. The elevation they are referring to is a QRS complex, which indicates a pneumothorax.