Acute Pericarditis Jackie Johnson diagnosis

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.

JJ has chest pain that is sharp and retrosternal. This pain radiates to her back and is pleuritic in nature, as it is worse when she takes a deep breath. This pain is improved when she leans forward. The driving factor towards the likely diagnosis is the three-component high pitched squeaking sound with cardiac auscultation. This is a pericardial rub. With all these factors combined, JJ likely has acute pericarditis.

Continual inflammation of the pericardium can often lead to fibrosis and can eventually lead to constrictive pericarditis. Jugular vein distention and an increase in the jugular vein pressure can be noted. Due to these symptoms, a differential diagnoses can include items such as constrictive pericarditis, pneumonia, GI reflux issues and even a pulmonary embolism, according to Hammer and McPhee (2019).

The most common causes of pericarditis are infections. Coxsackievirus is the most prominent viral cause, according to Hammer and McPhee (2019). Other causes can be bacterial, such as tuberculosis, pneumococcal, or staphylococcal, protozoal, such as amebiasis, or mycotic (fungal), such as actinomycosis, or coccidioidomycosis (Hammer & McPhee, 2019). Tests should be ran such as an EKG, CBC, BMP, troponin and lipase levels, and a CXR. I would suspect she has a viral case, due to her flu-like symptoms and an erythematous oropharynx. She also has clear mucus in her nasal passages. If these tests were to be ran, it would be likely she would an elevated WBC, erythrocyte sedimentation rate, or CRP level. Her EKG would be typical. The CXR can be helpful in ruling out other causes in the differential.
According to Hammer and McPhee (2019), pericarditis is an inflammation of the pericardium, and this inflammation affects the adjacent pleura. This can inflict pain when deep breathing or coughing.

Post-discharge, she should take good care of herself to prevent constrictive pericarditis or recurrent pericarditis. According to Imazio et al. (2016), 20-50% of all patients who are treated for pericarditis get it a subsequent time. She should continue to take all medications that she was prescribed, which can be colchicine or steroids, making sure to taper off these medications appropriately. According to Rahman (2017), low doses of colchicine can be safe, while higher doses or prolonged use can be toxic. She can also take NSAIDs, which can provide symptom control, faster remission rates, and reduction of subsequent recurrences, according to Imazio et al. (2016). These should only be taken if it is not contraindicated to take with her other medications. She should make follow up appointments to make sure this issue is solved.

Interestingly enough, there was a recent study done in 2020 by Fox et al. They found that multiple people who have had no past medical history who have had COVID-19 ended up having either pericarditis, effusive pericarditis, myopericarditis, or pericardial effusion when it was all said and done. There are no current recommendations for managing this, except colchicine, hydroxychloroquine, steroids or antivirals. If this case study is happening in present-day, it would be important to monitor signs and symptoms of pericarditis if the patent had COVID-19.


Fox, K., Prokup, J. A., Butson, K., & Jordan, K. (2020). Acute effusive pericarditis: A Late complication of COVID-19. Cereus, 12(7).

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Medical.

Imazio, M., Lazaros, G., Brucato, A., & Gaita, F. (2016). Recurrent pericarditis: new and emerging therapeutic options. Nature Reviews: Cardiology, 16.

Rahman, A. (2017). Pericarditis. AFP, 46(11).

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