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
