A previously healthy college student evaluates at the university health clinic reporting sharp, stabbing chest pain that started the day before. The discomfort is severely aggravated by lying flat in bed and taking deep breaths, but provides significant relief when the patient is sitting up and leaning forward. Vital signs reveal a temperature of 38.1°C (100.6°F), heart rate of 98/min, and blood pressure of 118/74 mm Hg. An electrocardiogram demonstrates diffuse, concave ST-segment elevations and PR-segment depressions across most limb and precordial leads. Cardiac troponin levels are within normal limits. Which of the following is the most appropriate initial pharmacological treatment for this patient's condition?
- Nonsteroidal anti-inflammatory drugs and colchicineAnswer
- BDual antiplatelet therapy and a high-dose statin
- CIntravenous loop diuretics and strict fluid restriction
- DInhaled short-acting beta-agonists and oral glucocorticoids
- EBroad-spectrum intravenous antibiotics
Answer
Nonsteroidal anti-inflammatory drugs and colchicine
The correct treatment is the combination of nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine. The patient's clinical presentation of sharp, pleuritic chest pain that improves with leaning forward, combined with diffuse ST-segment elevations and PR-segment depressions on an electrocardiogram, is classic for acute pericarditis. The standard first-line therapy for idiopathic or viral acute pericarditis consists of NSAIDs (such as ibuprofen or indomethacin) for symptom relief and inflammation reduction, alongside colchicine, which is critical for preventing recurrent episodes.
Step-by-Step Solution
Key Concept
Diagnosis and initial pharmacological management of acute pericarditis.