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  #1  
Old 09-28-2010
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Heart Substernal Chest pain changes with position

A 35-year-old male complains of substernal chest pain aggravated by inspiration and relieved by sitting up. Lung fields are clear to auscultation, and heart sounds are somewhat distant. Chest x-ray shows an enlarged cardiac silhouette.

Which of the following is the best next step in evaluation?

a. Right lateral decubitus chest x-ray
b. Cardiac catheterization
c. Echocardiogram
d. Serial ECGs
e. Thallium stress test
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  #2  
Old 09-28-2010
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That's pericarditis, the best test is ECHO
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Old 10-15-2010
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distant sounds & relieve after sitting up and leaning forward;
pericarditis
diagnosis with serial ECG that shows diffuse ST elevation in almost all leads,
echo would only show some fluid, maybe not.
choice D
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Old 10-17-2010
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The diagnosis for sure is pericarditis.

My answer is C i.e., Echocardiography. In this case the x-ray clearly identifies fluid by showing enlarged cardiac size along with distant heart sound on physical exam. Echo will tell us the amount of fluid so that we could select either medications and/or drainage.
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Old 10-17-2010
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we should diagnose & treat pericarditis based on etiology;
is it idiopathic? if yes so do serial ecg and treat with NSAIDS cause it has viral causative.
is it uremic? if yes so do ecg,echocardiography and treat with dialysis.
although we don't have complete medical history in q stem but you're right "n elham" ,seeing enlarged cardiac silhouete means that at least 250 ml of fluid has been accumulated in pericard and echo will help.
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