- 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?
b. ECG
An Electrocardiogram (ECG) is the best method for differentially diagnosing pericarditis from other similar conditions such as a myocardial infarction or pulmonary embolism. Pericarditis can be distinguished by the presence of PR depressions and the absence of Q waves. ABG, heart sounds, or an X-ray would not be able to distinguish this condition as pericarditis. -
- True or false. Pericarditis is the most commonly suspected diagnosis for patients experiencing chest pain.
False. Retrosternal chest pain is more commonly associated with conditions such as MI, CAD, or even GERD. Differential diagnosis is difficult for pericarditis due to its commonality of symptoms to other conditions. - When examining a patient with pericarditis, a pericardial friction rub is detected. What distinguishes a pericardial friction rub from a pleural friction rub?
c. A pericardial friction rub can still be detected with the cessation of breathing.
A friction rub is an audible medical sign. Pleural friction rubs can only be heard during inspiration and expiration, whereas, pericardial friction rubs can be heard even when the patient is not breathing. Pleural friction rubs can be detected more laterally compared to pericardial friction rubs. - 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?
b. More fluid surrounding the heart allows for less blood to fill the heart to be pumped out leading to poor circulation.
The additional fluid in the pericardial sac actually can begin to compress the heart. In severe cases it can lead to cardiac tamponade, but overtime, the heart will have to fight to contract and can lead to heart failure and reduced cardiac output.
- 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.
Sublingual nitroglycerin is often used to prevent angina and myocardial infarction. Due to the evidence of the pericaridal rubs with air exchange, a PR depression and ST elevation could be indicative of pericarditis, an inverted T wave could be related to a pulmonary embolism.