Acute Pericarditis Discussion Essay

Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.

In this discussion:

  1. Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?
  2. Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?
  3. Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
  4. Identify the pathophysiologic mechanism for her chest pain.
  5. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Discussion 2, Moule 2

1. The most likely diagnosis for Jackie Johnson is acute viral pericarditis. She presented to the ED with “flu-like illness”, with fever, nasal drainage, and cough. Given her neg. medical history and description of chest pain, this would also fit with viral pericarditis. Also, it was noted on auscultation, a three-component high-pitch squeaking sound, a friction rub, is a hallmark sign of pericarditis.

2. The differential diagnoses would include M.I., P.E., Pneumonia, COVID, and Aortic Dissection. Chest pain in a 35-year-old female would be worked up with a thorough physical exam, complete patient history, and diagnostic testing because the M.I., P.E., Pneumonia, COVID, and Aortic Dissection all can have chest pain as a presenting complaint.

3. Viral infections (especially infections with coxsackieviruses and echoviruses), and probably are responsible for many cases classified as idiopathic. (Norris, 2019).  Infections may be bacterial, fungal, or viral. Other causes can be Neoplasms, high dose radiation to the chest, uremia, hypersensitivity, or autoimmune diseases such as acute rheumatic fever (the most common cause of pericarditis in children), lupus, and rheumatoid arthritis. Causes may also include previous cardiac injury, post-M.I. or surgery, that leaves the pericardium intact but causes blood to leak into the pericardium. (Lippincott, 2005). Viral pericarditis is the most likely diagnosis.

4. The chest pain is due to a result of pericardium inflammation. The inflammation of the adjacent pleura may account for the worsening pain with deep breathing and coughing. (Hammer & McPhee, 2019). With prolonged inflammation, the pericardium can become fibrotic and scarred, with calcium deposits, and this, in turn, can lead incomplete filling of the ventricles  resulting in constrictive pericarditis (Hammer & McPhee, 2019)

5. Upon discharge from the ED or from an inpatient status, her plan of care should be close follow up with her primary MD or possibly cardiology, depending on labs, EKG, chest x-ray, echo, etc. She may possibly need education on stress management due to her job as an advertising executive. Instructions are given on a healthy diet and exercise. She will be on a short course of NSAIDs and possibly colchicine. If NSAIDs are ineffective and no infection exists, corticosteroids can be given. (Lippincott,2005). Her social support, we can assume is her husband, and I would stress healthy life habits for them as a couple.


Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of Disease. New York: McGraw-Hill Education.

Lippincott, W. &. (2005). Handbook of Pathophysiology. Philadelphia: Wolters Kluwer.

Norris, T. L. (2019). Porth’s Pathophysiology Concepts of Altered States. Philadelphia: Wolters Kluwer.

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