Case history
Case history
An otherwise healthy 30-year-old man presents with a several-day history of progressive, severe, retrosternal chest pain that is sharp and pleuritic in nature. The pain is worse on lying down and improved with sitting forward. There is radiation to the neck and shoulders and specifically to the trapezius muscle ridges. The pain is constant and unrelated to exertion. On physical examination, a pericardial friction rub is heard at end-expiration with the patient leaning forward.[11][12]
Other presentations
A monophasic, biphasic, or triphasic pericardial friction rub is pathognomonic of acute pericarditis with virtually 100% specificity. The rub can come and go over hours, so the sensitivity is based upon the frequency of cardiac auscultation, and it is important to examine patients with suspected pericarditis repeatedly.[13] In a significant pericardial effusion, there can be signs of cardiac tamponade such as tachycardia, tachypnoea, pulsus paradoxus, and Beck's triad (hypotension, jugular venous distention, and distant heart sounds).[14] The presence of high, spiking fevers indicates an infectious aetiology. A prodrome of myalgias and malaise may be reported, particularly in young adults.[14] The patient may also present with a recent history of an upper respiratory tract infection or diarrhoeal illness.[15]
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