HPIA 35 yo female presents to the ED with chest pain that started this morning.

HPIA 35 yo female presents to the ED with chest pain that started this morning. www.phwiki.com

HPIA 35 yo female presents to the ED with chest pain that started this morning.

Gordon, Greg, Coordinating Producer has reference to this Academic Journal, PHwiki organized this Journal HPIA 35 yo female presents to the ED with chest pain that started this morning. She had cold-like symptoms earlier in the week. She has an important presentation at work this afternoon about her recent meeting with investors in Japan in addition to wants to know how long it is going to take to find out what is wrong.What else would you like to askHPIOnsetSettingSeverityQualityLocation, RadiationDurationFrequencyAggravating FactorsAlleviating FactorsAssociated SymptomsHPIOnset – Sudden, acuteSetting – Started when she woke up this morningSeverity – 10/10!Quality – SharpLocation, Radiation – Left-sided, radiating to left shoulderDuration – 2 hoursFrequency – No previous episodesAggravating Factors – Inspiration, lying down, coughing, swallowingAlleviating Factors – Sitting up in addition to leaning as long as wardAssociated Symptoms – palpitationsWhat else do you want to know

Stewart School SD www.phwiki.com

This Particular University is Related to this Particular Journal

PMHMedical Hx: C-section (2009)Family Hx: non-contributory, no family history of heart disease or bleeding disordersSocial: Married with 2 children, works in finance, one glass of wine per week, denies tobacco in addition to illicit drug useWhat is your differential diagnosisDDxAcute MIPulmonary EmbolismPneumothoraxPneumoniaPericarditisAsthmaGERDAnxietyWhat do you want to do nextPhysical ExamVitals: BP 120/80, T 99.0, HR 80, RR 20General: Patient is sitting on the edge of the hospital bed leaning as long as wardHEENT, Abdominal, Neuro, in addition to Psych Exams: wnlCV: RRR, no murmurs, rub heard at left lower sternal border at the end of expirationRespiratory: shallow breaths, able to speak in full sentences, lungs clear to auscultation bilaterallyWhat labs do you want to order in addition to why

Lab TestsCardiac Markers – rule out MICBC – evaluate as long as infection, inflammationElectrolytes – increased risk of arrhythmias in pericarditisCRP, ESR – evaluate as long as inflammationD-dimer – rule out PE (low suspicion)CXR – evaluate as long as pneumonia, pneumothorax, PE, effusionECG – rule out MI, pericarditisLab ResultsTroponin I – < 10 g/LCBC, electrolytes – normal CRP – 16 mg/LESR – 25 mm/hD-Dimer – 100 ng/mL ECGWhat’s your impression of the ECG Widespread ST elevation without reciprocal depressionPR depression in lead IIChest X-RayNote the cardiomegalyHow can we further evaluate this enlarged heartCardiac Echo shows pericardial effusionRV – right ventricleLV – left ventricleLA – left atriumAo – aortaPE – pericardial effusion Chest CTThick arrow – pericardial effusionThin arrow – pleural effusionOverview of Acute PericarditisInflammation of the pericardial sac accompanied by pericardial effusion “Bread in addition to Butter Heart”Histology of Acute PericarditisPMNs adhering to the epicardium Overview of Acute PericarditisMany possible causes, including:Idiopathic (usu. post-viral)Infection (viral, bacterial, fungal)Acute MIDressler’s syndromeSLEDrug-induced (procainamide, hydralazine)AmyloidosisRadiationPost-surgeryHallmarks of Acute PericarditisSymptoms: Chest painPleuritic, associated with breathingPositional relieved by sitting up in addition to leaning as long as wardDyspneaPalpitations+/- fever, non-productive coughHallmarks of Acute PericarditisECG Changes – diffuse ST-segment elevation in addition to PR depressionPhysical Exam Findings:Friction rubPulsus paradoxusDistant Heart Sounds Pericardial Friction RubPathognomonic as long as acute pericarditisHeard best at left lower sternal edge with patient sitting up, leaning as long as ward, & exhalingHigh-pitched, grating sound with 3 componentshttp://www.youtube.com/watchv=J1R8OxgqhfkPulsus Paradoxus> 10 mmHg fall in systolic blood pressure during inspirationSeen with cardiac tamponade, asthma, pericarditisTreatmentNSAIDs, medium to high doses – 1st lineCorticosteroids – if NSAIDs fail or are contraindicated, recurrent pericarditisColchicine – prevents recurrent pericarditisPericardiocentesis – as long as large effusion with hemodynamic compromise, cardiac tamponade, or diagnostic purposesPericardiectomy – as long as persistent constrictive pericarditis

PearlsAcute Pericarditis Key Findings (need 2 of 4 as long as diagnosis):Pleuritic chest pain improved by leaning as long as wardPericardial friction rubWidespread ST elevation on ECGPericardial effusionSummaryThe patient was diagnosed with acute pericarditis in addition to started on NSAID therapyShe continued to be in stable condition in addition to was discharged from the ED with instructions to follow-up with her PCPShe was told to expect her symptoms to resolve in 2 weeks to 3 months

Gordon, Greg Overnight Productions Inc. Coordinating Producer www.phwiki.com

Gordon, Greg Coordinating Producer

Gordon, Greg is from United States and they belong to Overnight Productions Inc. and they are from  Los Angeles, United States got related to this Particular Journal. and Gordon, Greg deal with the subjects like Gay/Lesbian

Journal Ratings by Stewart School

This Particular Journal got reviewed and rated by Stewart School and short form of this particular Institution is SD and gave this Journal an Excellent Rating.