Critical Care Medicine-Infections and Immunologic Disease>>>>>Cardiovascular Infections
Question 4#

A 79-year-old female with ESRD presents to the intensive care unit with 7 days of worsening dyspnea on exertion, lower extremity edema, malaise, and chest pain that radiates toward the left shoulder that is worse with inspiration. Vitals are:

• temperature 38.5°F
• blood pressure 105/90 mm Hg
• heart rate 95 beats/min
• respiratory rate 21/min

Electrocardiogram (EKG) reveals ST elevations in leads I, II, III, aVF, and aVL.

What is the MOST common etiology of this patient’s condition?

A. Viral infection
B. Myocardial infarction
C. Bacterial infection
D. Renal failure

Correct Answer is A

Comment:

Correct Answer: A

This patient is describing signs and symptoms of acute pericarditis, which most commonly occurs because of a viral infection with patients often recalling a nonspecific prodrome of fever, malaise, and pleuritic chest pain that radiates toward the left shoulder and is worse with inspiration and relieved by leaning forward. The other choices describe other less frequent causes of acute pericarditis. ST elevations are diffusely seen in all or many EKG leads in acute pericarditis and can be differentiated from a ST elevation myocardial infarction by not having ST depressions in reciprocal leads (ie, ST elections in both high lateral leads I and aVL and reciprocal inferior leads II, III, and aVF).

Reference:

1. Goyle KK, Walling AD. Diagnosing pericarditis. Am Fam Physician. 2002;66(9):1695-1702.