A 26-year-old woman has sharp left precordial non-radiating chest pain preceded by 2 to 3 days of sore throat, diffuse myalgias, and malaise. Deep breaths aggravate the chest pain. She has always been healthy. On examination, temp 36.7 PC, HR 95/min, RR 24/min, and BP 110/60 mmHg, Jugular veins are not distended. Lungs are clear, Cardiac examination is notable for an intermittent systolic "squeaky" sound along the left sternal border. ECG shows diffuse ST elevation with an upwardly concave configuration. An echocardiogram shows no pericardial effusion. Which of the following is the most appropriate initial treatment for this patient?
سؤال مجاني 2 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة والشرح
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الإجابة: C. Indomethacin
Post-viral pleuritic chest pain, a friction rub and diffuse concave ST elevation with no effusion = acute (viral) pericarditis. First-line therapy is a high-dose NSAID such as indomethacin (plus colchicine). Prednisone is second-line for NSAID contraindication/refractory cases (linked to recurrence), and clopidogrel/heparin are ACS treatments that could cause haemorrhagic effusion.
ليش كل خيار صح أو غلط
-
A
ليش غلط
Clopidogrel is a P2Y12 receptor inhibitor (antiplatelet) used to reduce thrombosis in ischemic heart disease. It is not a treatment for pericarditis.
✓ (Y4)-(M B) Ischemic Heart and Acute coronary syndrome.pdf · p. 18 -
B
ليش غلط
Heparin is an anticoagulant (it enhances antithrombin III) used in ischemic heart disease such as STEMI, NSTEMI and unstable angina, not for pericarditis.
✓ (Y4)-(M B) Ischemic Heart and Acute coronary syndrome.pdf · p. 18 -
C
ليش صح
First-line therapy for acute pericarditis is high-dose NSAIDs (including indomethacin), with colchicine as an add-on.
✓ Step Up To Medicine 6th(Pericardial disease).pdf · p. 3 -
D
ليش غلط
Glucocorticoids (prednisone) are only for pain that does not respond to NSAIDs and should be avoided if possible because of a high rate of recurrent pericarditis.
✓ Step Up To Medicine 6th(Pericardial disease).pdf · p. 3
- المصدر
- CARDIOLOGY - PERICARDIAL DISEASES.pdf · p. 5
Step Up To Medicine 6th(Pericardial disease).pdf · p. 3 - المحاضرة
- Pericardial Disease · Cardiology · Module B
- ظهر في
- Cardio bank