Cardiovascular · Year 1 · from Cardiovascular
Case 1: Acute Pericarditis with Pericardial Effusion
Patient Presentation
Demographics: 32-year-old male
Chief Complaint: Sharp chest pain for 2 days
History of Present Illness: A 32-year-old previously healthy male presents with sharp, stabbing chest pain that started 2 days ago. The pain is worse when lying flat and improves when sitting forward. He reports a recent viral upper respiratory infection 1 week ago. He also notes low-grade fever and fatigue.
Physical Examination:
- Vital Signs: BP 118/72 mmHg, HR 98 bpm, RR 18/min, Temp 38.1°C, SpO2 98% on room air
- General: Anxious-appearing male, sitting forward
- Cardiovascular: Pericardial friction rub heard at left lower sternal border (three-component scratchy sound)
- Lungs: Clear to auscultation bilaterally
- JVP: Normal
Workup
- ECG: Diffuse ST-segment elevation with PR depression in multiple leads (concave upward ST elevation)
- Echocardiogram: Small pericardial effusion (0.8 cm), normal LV function
- Labs:
- Troponin I: 0.08 ng/mL (mildly elevated)
- WBC: 11,200/μL
- ESR: 45 mm/hr
- CRP: 6.2 mg/dL
Diagnosis
Acute viral pericarditis with small pericardial effusion and mild myopericarditis
Anatomical Correlation: The pericardium consists of the fibrous pericardium (outer layer) and serous pericardium (parietal and visceral layers). The pericardial cavity normally contains 15-50 mL of fluid. Inflammation of the pericardium causes the characteristic friction rub heard when roughened pericardial surfaces rub together.
Treatment
- NSAIDs (Ibuprofen 600 mg TID for 1-2 weeks)
- Colchicine 0.5 mg BID for 3 months (reduces recurrence)
- Activity restriction until symptoms resolve
- Serial echocardiography to monitor effusion
Clinical Image
Image Description: Echocardiogram showing pericardial effusion as an echo-free space surrounding the heart. The pericardial fluid appears as a dark (anechoic) space between the visceral and parietal pericardium.
Source: Wikimedia Commons - Echocardiography of pericardial effusion License: CC BY-SA 4.0 URL: https://commons.wikimedia.org/wiki/File:Pericardial_effusion_with_tamponade.gif