MEDizzy - Three weeks following a myocardial infarction, a 54-year-old

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Cardiovascular System

Three weeks following a myocardial infarction, a 54-year-old man presents with fever, productive cough, and chest pain. The pain is worse with inspiration, better when he is sitting up, and not relieved by nitroglycerin. Physical examination finds a friction rub along with increased jugular venous pressure and pulsus paradoxus (excess blood pressure drop with inspiration). Which of the following is the most likely explanation for these findings?

ExplanationCardiac rupture is most frequent at 4 to 7 days post-MI, while fibrinous pericarditis usually develops around day 2 to 3. Pericarditis that develops approximately 1 to 3 weeks following an MI is called Dressler syndrome (not Caplan syndrome, which refers to the combination of rheumatoid arthritis and pneumoconiosis). This is an autoimmune disorder. Pericarditis refers to inflammation of the pericardium. Patients develop severe retrosternal chest pain that is typically worse with deep inspiration or coughing. Physical examination reveals the characteristic pericardial friction rub. ECG changes and pulsus paradoxus are also present. Pericarditis developing after a myocardial infarct is usually either serous or serofibrinous. Serous pericarditis contains few inflammatory cells and may also result from uremia or autoimmune diseases such as systemic lupus erythematosus (SLE). Serofibrinous pericarditis has a fibrinous exudate mixed with the serous fluid and may result from uremia or viral infections. Other types of pericarditis include purulent (suppurative) pericarditis with many inflammatory cells (seen with bacterial infections) or hemorrhagic pericarditis (seen with carcinoma or tuberculosis).