WBR0019

Author	PageAuthor::Aarti Narayan, Raviteja Reddy Guddeti
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Internal medicine, MainCategory::Emergency Room
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 75 yr old male presents to the ER with chest pain of 20 minutes duration. His EKG shows ST-elevation in the anterior precordial leads, and laboaratory studies show an elevation of cardiac enzymes. The patient was found to have 3 vessel disease on coronary angiography. Immediate CABG was done and the patient recovered well post-surgery. He was discharged in in stable condition. The patient presents again to the ER two weeks later, this time complaining of chest pain that is severe and retrosternal which radiates to the back. On further inquiry he mentions that his pain is aggravated by lying down and alleviated by sitting up and leaning forward. What is the most probable diagnosis?]]
Answer A	AnswerA::Dressler’s syndrome
Answer A Explanation	AnswerAExp::Dressler's syndrome or is a form of pericarditis that occurs in the setting of injury to the heart as a result of myocardial infarction. Dressler's syndrome typically occurs 2 to 10 weeks after myocardial infarction.
Answer B	AnswerB::Post-myocardial infarction pericarditis
Answer B Explanation	[[AnswerBExp::Post-myocardial infarction pericarditis, similar to Dressler's syndrome, is a pericarditis which occurs after a myocardial infarction. However Dressler's syndrome will occur 2-10 weeks after an MI, whereas post-myocardial infarction pericarditis occurs 2-4 days after a myocardial infarction.]]
Answer C	AnswerC::Post-pericardiotomy syndrome
Answer C Explanation	AnswerCExp::Post-preicardiotomy syndrome is the correct answer.
Answer D	AnswerD::Pulmonary embolism
Answer D Explanation	[[AnswerDExp::Pulmonary embolism is a large clot that gets lodged in the lungs, and is associated with sudden onset chest pain, tachycardia, and shortness of breath. History is usually significant for a history of immobility, a past thromboembolic event, and risk factors for a hypercoagulable state.]]
Answer E	AnswerE::Idiopathic
Answer E Explanation	AnswerEExp::The history of the patient suggests that cardiac surgery is the inciting factor for the pericarditis in this case.
Right Answer	RightAnswer::C
Explanation	[[Explanation::The correct answer is post-pericardiotomy syndrome. The post-pericardiotomy syndrome is inflammation of the pericardium (the sac surrounding the heart) that occurs following cardiac surgery. Symptoms can occur from days to weeks after the operation. The syndrome is thought to have an autoimmune basis. Educational Objective: References: ]]
Approved	Approved::No
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