The mother of an 8-year-old girl sought medical care for her daughter who had complained of intermittent chest pain for 3 days. The patient denied nausea, vomiting, and diarrhea. There was no shortness of breath, chills, fever, or diaphoresis. Her travel history included 2 trips to Mexico within the past year; the most recent trip ended 3 months before the pain started. The patient described her pain while standing and playing as 7 on a scale of 1 to 10 (10 being the most painful); her pain when resting was 3 of 10. Vital signs were stable; there was no clubbing, erythema, cyanosis, or jugular venous distention. No murmur or gallop was heard; a very mild pericardial friction rub was noted. Pain increased with palpation of the left upper quadrant. The lungs, abdomen, and extremities were normal; the patient was neurologically intact. The complete blood cell count and a complete metabolic profile were normal; the erythrocyte sedimentation rate (ESR) was 20 mm/h. A chest film showed no acute changes. Diffuse ST-segment elevations were evident on the ECG; an echocardiogram revealed no pericardial effusion. Heart rate was 66 beats per minute. Acute pericarditis was diagnosed. Dr Sudhir R. Gogu of Plainview, Tex, comments that a variety of infectious and noninfectious processes can cause pericarditis; the idiopathic and viral forms are most common. Frequently, the patient presents with flu-like symptoms of malaise, arthralgias, myalgias, and a lowgrade fever. Classic findings are pericardial friction rub and ECG changes, such as widespread ST-segment elevation in most leads. Usually, no Q waves or ST-segment depressions are noted. The ST-segment elevations return to baseline as the disease resolves. Cardiac enzymes are normal. Other diagnostic clues to acute pericarditis are pericardial effusion, an elevated ESR, and leukocytosis. Acute pericarditis is self-limited in most patients. A 10-day course of bed rest, NSAIDs, and low-dose prednisone relieved this patient’s symptoms. FOR MORE INFORMATION:
- Mewar SH, Shamsi SN, Anjur-Kapali N, Spodnick DH. Acute pericarditis. Curr Treatment Options Cardiovasc Med. 1999;1:73-77.