A 32-year-old white man presented initially with low-grade fever, cough, and pleuritic chest pain. He was found on ECG to have diffuse ST-segment elevation. A transthoracic echocardiogram (TTE) revealed a large pericardial effusion, and serologies were positive for coxsackievirus B infection. He was diagnosed with acute viral pericarditis and treated with indomethacin. He returns 4 weeks later for follow-up and states that he no longer has any pain, but he notes some mild ankle swelling. His ECG is normal. A repeat TTE shows resolution of the effusion but new findings consistent with mild constriction.
What is the next step in managing this patient?A. Obtain cardiac MRI to better assess the pericardium
Reassure the patient and observe him over the next 3 months for worsening of symptoms. The natural history of acute viral or idiopathic pericarditis is usually short and self-limited. Occasionally, mild forms of constriction may develop weeks after the initial event, but they usually resolve without any specific treatment. No further treatment is indicated unless he becomes more symptomatic or develops signs of cardiac tamponade.