A 60‐year‐old white woman with a history of coronary artery disease presented with a 2‐day history of dyspnea and pleuritic chest pain. The chest pain varied in its intensity, and it increased with deep inspiration. She denied radiation of the chest pain, diaphoresis, nausea, vomiting, or coughing, but she did report subjective fevers and chills. Three weeks previously, she had been admitted to the hospital with a different type of chest pain and ultimately had a percutaneous coronary intervention to her right coronary artery. She was discharged home on aspirin and Plavix. Her initial vital signs were: temperature, 97.1°F; heart rate, 71; blood pressure, 107/77; respiratory rate, 20; and room‐air oxygen saturation, 98%. The physical examination was normal, except for pain when pressure was applied to the midsternum. The patient had 3 negative sets of cardiac enzymes, and her electrocardiogram was normal. Her white blood celll count was 17.1, C‐reactive protein was 26.2 mg/dL, and erythrocyte sedimentation rate was 53 mm/h. Because her D‐dimer was mildly elevated, at 0.8 μg/mL, the patient went for a chest CT angiogram, which showed no pulmonary embolus but did reveal a new (that is, since August 26, 2010) “sizable pericardial effusion.” Her transthoracic echocardiogram showed a small‐ to moderate‐sized pericardial effusion, without echocardiographic findings of increased intrapericardial pressure.
Acute pericarditis is a diagnosis commonly encountered by hospitalists. Patients must have at least 2 of these 4 criteria to be diagnosed with pericarditis: pericardial effusion, chest pain, abnormal electrocardiogram (with diffuse ST elevation or PR depression), and a pericardial friction rub. Although in many instances the etiology of acute pericarditis is idiopathic, there are multiple known causes, including infections, neoplasms, metabolic disorders, vasculitis, connective tissue diseases, and trauma. Trauma can be either direct or indirect. Indirect trauma includes blunt injury to the chest. Examples of direct trauma include penetrating chest injury or cardiac surgery. Although not commonly considered, direct trauma can also occur during a percutaneous coronary intervention and lead to acute pericarditis. The development of acute pericarditis after such interventions has been reported only infrequently in case reports. The treatment of acute pericarditis resulting from percutaneous coronary interventions is the same as for the treatment of other types of pericarditis. As is true for most cases of acute pericarditis, in less than 1 week, this patient's symptoms responded well to the use of Indocin and colchicine.
Although it is very important to first exclude acute coronary syndrome due to in‐stent re‐stenosis as a cause of chest pain in a patient who has recently undergone a percutaneous coronary intervention, acute pericarditis should also be included in the differential diagnosis.
K. Clarke ‐ none
To cite this abstract:Clarke K. Not Just Another Case of Acute Pericarditis. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 253. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/not-just-another-case-of-acute-pericarditis/. Accessed April 5, 2020.