The Correct Answer is A!

 

A 33-year-old otherwise healthy man presents with low-grade fevers and three days of severe chest pain radiating to the back and arms. It is worsened by lying down and deep inspirations. On exam, BP 115/70 without paradox, HR 80, and there is normal venous pressure. There is a three-component rub at the LLSB. The ECG is shown. There is an elevated sedimentation rate of 55 mm/hr.

Which is the most useful test for management of this patient?

Sedimentation Rate

A. Troponin
B. CT angiography
C. MRI scan with gadolinium
D. Echocardiogram

Rationale:

This patient has classic acute pericarditis as evidenced by the history, the friction rub and the diffuse ST concave upward elevations and PR depression. No other test is required for diagnosis. Troponin levels are useful for prognosis and determining need for hospitalization, indicating concomitant myocarditis if elevated. An echocardiogram can be done but is not required in the absence of clinical signs of pericardial tamponade.

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