23yo M presents with 2 days of substernal CP associated with fevers and dizziness, he called EMS for a near syncopal episode today.

His triage vitals:

Temp: 102.1  HR: 105 HR: 126/64 RR: 18 O2: 99% RA

Exam: unremarkable exam: no murmurs/rubs, clear lungs, no rash, no signs of trauma.

His EKG is below (click to enlarge):

 

 

Based on this history and EKG, what is your diagnosis?

 

What high-risk features would push you toward admission rather than outpatient management?

 

Diagnosis: Pericarditis (diffuse ST elevations and PR depressions [PR elevation in aVR])

 

High-risk features that make admission advisable:

Severe Infection Concerns

1) Fever and leukocytosis

2) Immunosuppressed state

Tamponade Risk

3) Evidence suggesting cardiac tamponade

4) A large pericardial effusion (<20 mm)

5) A history of oral anticoagulant therapy

Trauma
6) Acute trauma

Failure of OP management
7) Failure to respond within seven days to NSAID therapy

Myocarditis
8 ) Elevated cardiac troponin, which suggests myopericarditis