Inflammation of The Pericardium Essay Discussion

chest pain for 2 years. The current pain had come on 4 hours earlier at 8 p.m. and has been persistent since then. It is central in position, with some radiation to both sides of the chest. It is not associated with shortness of breath or palpitations. The pain is relieved by sitting up and leaning forward. Two Tylenol tablets taken earlier at 9 p.m. did not make any difference to the pain. The previous chest pain had been occasional, lasting a second or two at a time and with no particular precipitating factors. It has usually been on the left side of the chest although the position has varied. Two weeks previously he had mild to moderate symptoms of COVID-19 which lasted 14 days. This consisted of a sore throat, low-grade fever, loss of taste and smell, and a cough. His wife and two children were ill at the same time with similar symptoms but have been well since then. He has a history of migraines. In the family history, his father had a myocardial infarction at the age of 51 years and was found to have a marginally high cholesterol level. His mother and two sisters, aged 36 and 38 years, are well. After his father’s infarct, he had his lipids measured; the cholesterol was 5.1 mmol/L (desirable range < 5.5 mmol/L). He is a nonsmoker who drinks two 12-packs of beer per week. Inflammation of The Pericardium Essay Discussion

Examination

His pulse rate is 75/min, blood pressure 124/78 mmHg. His temperature is 37.8C. There is nothing abnormal to find in the cardiovascular and respiratory systems. The ECG findings include diffuse concave-upward ST-segment elevation and, occasionally, PR-segment depression.

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Differential Diagnoses

Pericarditis (l30.9): refers to inflammation of the pericardium which is a double-layered fibro elastic sac which surrounds the heart. The aetiology can be divided into infectious and non-infectious causes. Viral causes are the most common cause and include; echovirus, adenovirus, or coxsackie virus A and B, influenza, HIV and others. Bacterial causes include; pneumococcus, streptococcus and staphylococcus and rarely fungal causes such as; candida and histoplasma. Non-infectious causes consist of; connective tissue disease, malignancy and metabolic disease (Imazio & Gaita, 2017). The classic manifestation of pericarditis is chest pain that is centrally located, worsened on inspiration and relieved by sitting up and leaning forward. It is accompanied with new widespread ST-elevation and PR depression on ECG. Patients may have prodromal flu-like symptoms such as upper respiratory symptoms and fever. Inflammation of The Pericardium Essay Discussion

Acute myocardial infarction (l21.9): it is caused by reduced or complete cessation of blood supply to the myocardium. INTERHEART has delineated some risk factors associated include; advance age, sex (male gender tend to have MI earlier in life, family history, obesity, diabetes, smoking, sedentary lifestyle, dyslipidaemia, hypertension and others (Anderson & Morrow, 2017). Patients often present chest pressure or discomfort that radiates to the shoulder, jaw, neck or arm. It is often associated with ECG changes.

Pleurisy (R09.1): it results from disease causing inflammation of the pleura and is characterized by localized pain. Causes include; bacterial and viral pneumonia which develops over hours to days, in emergencies such as; pulmonary emboli, pneumothorax, acute pericarditis, acute coronary syndrome and chest wall trauma (Reamy, Williams & Odom, 2017). Risk factors include; previous upper respiratory tract infection, IV drug use, cigarrete /tobacco smoking, alcohol consumption and others.

References

Anderson, J. L., & Morrow, D. A. (2017). Acute myocardial infarction. New England Journal of Medicine, 376(21), 2053-2064.

Imazio, M., & Gaita, F. (2017). Acute and recurrent pericarditis. Cardiology Clinics, 35(4), 505-513.

Reamy, B. V., Williams, P. M., & Odom, M. R. (2017). Pleuritic chest pain: sorting through the differential diagnosis. American family physician, 96(5), 306-312.

Based on the following information, create a list of three differential diagnoses and explain why you would include them on your list. Inflammation of The Pericardium Essay Discussion

History
C.R., a 34-year-old man, came to your clinic with an episode of chest pain. He has a previous history of occasional stabbing chest pain for 2 years. The current pain had come on 4 hours earlier at 8 p.m. and has been persistent since then. It is central in position, with some radiation to both sides of the chest. It is not associated with shortness of breath or palpitations. The pain is relieved by sitting up and leaning forward. Two Tylenol tablets taken earlier at 9 p.m. did not make any difference to the pain.

The previous chest pain had been occasional, lasting a second or two at a time and with no particular precipitating factors. It has usually been on the left side of the chest although the position has varied.

Two weeks previously he had mild to moderate symptoms of COVID-19 which lasted 14 days. This consisted of a sore throat, low-grade fever, loss of taste and smell, and a cough. His wife and two children were ill at the same time with similar symptoms but have been well since then. He has a history of migraines. In the family history, his father had a myocardial infarction at the age of 51 years and was found to have a marginally high cholesterol level. His mother and two sisters, aged 36 and 38 years, are well. After his father’s infarct, he had his lipids measured; the cholesterol was 5.1 mmol/L (desirable range < 5.5 mmol/L). He is a nonsmoker who drinks two 12-packs of beer per week. Inflammation of The Pericardium Essay Discussion

Examination
His pulse rate is 75/min, blood pressure 124/78 mmHg. His temperature is 37.8C. There is nothing abnormal to find in the cardiovascular and respiratory systems. The ECG findings include diffuse concave-upward ST-segment elevation and, occasionally, PR-segment depression. Inflammation of The Pericardium Essay Discussion