MDM //
with positional chest pain for the past 2 days_. Recent mild cough, sore throat_. EKG obtained consistent with pericarditis. BUS w/o overt tamponade or significant effusion. Query possible recent URI as trigger. No overt e/o AKI or CKD, malignancy, HIV, TB. No overt high risk factors for complicated pericarditis including fever, no e/o large pericardial effusion or tamponade, no immunosuppression, anticoagulation, or trauma. Low suspicion given history and exam for concurrent myocarditis, ACS or PE. Discussed activity restriction until symptom resolution. Discussed treatment with NSAIDS (ibuprofen TID per ESC guidelines) with low risk for GIB (no history of PUD, age < 65, and no concurrent anticoagulation) and cotreatment with colchicine given lack of risk factors for toxicity (low suspicion for CKD given age) and potential benefits (significant reduction in the risk of recurrence - ICAP trial NEJM 2013)_. Discussed need for close follow up with ASHE and cardiology referral as well as strict return precautions for worsening chest pain, signs of CHF/fluid overload/tamponade, or infection.
[Back to Main Menu]