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  #1  
Old 10-28-2011
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Heart Chest pain after MI

A 56-year-old white male complains of recurrent chest pain while he is in CCU three days after a large transmural anterior wall myocardial infarction. He received thrombolytic therapy and anticoagulation with heparin. The chest pain is central, 6/10 in severity, radiates to the back, is worsened by deep breathing, and relieved by sitting up. Sublingual nitroglycerin has no effect on his pain. His vitals are, PR: 80/min; BP: 125/70 mmHg; Temperature: 37C(98.6F); RR: 14/min. His lungs are clear to auscultation. Heart sounds are normal with no murmurs and a pericardial friction rub is present. Chest x-ray shows normal sized heart and clear lung fields. EKG shows diffuse new ST segment elevation that is concave upwards. Troponins are still elevated and CK-MB is normal. Based on these findings, what is the most likely diagnosis in this patient?

A.
Acute pericarditis
B.
Recurrent ischemia
C.
Recurrent infarction
D.
Dresslerís syndrome
E.
Pulmonary embolism
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Old 10-28-2011
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A)acute pericarditis
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Old 10-28-2011
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A.acute pericarditis
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Old 10-28-2011
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considering its just three days aftr MI,it has to be fibrinous pericarditis ...Dresslers would take a few weeks
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Old 10-28-2011
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Is it A:Acute Pericarditis..
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yup acute pericarditis. the leaning fwd with lessening of symptoms with friction rub should have given the answer away.
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Old 03-31-2013
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Acute pericarditis
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Old 03-31-2013
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Default acute pericarditis

in addition to the pathognomic physical findings, even the ecg is very specific: upsloping ST segments are found in pericarditis.

in addition the CK MB is normal, that rules out new MI
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