24-Year-Old Man With Acute Chest Pain
The patient underwent initial laboratory studies, which revealed the following (reference ranges provided parenthetically): hemoglobin, 8.1 g/dL (12.0-15.5 g/dL); white blood cell count, 5.4 109/L (3.5-10.5 109/L), with a differential of 85% neutrophils and 9% lymphocytes; platelet count, 299 109/L...
Saved in:
Published in | Mayo Clinic proceedings Vol. 92; no. 12; pp. 1850 - 1854 |
---|---|
Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
England
Elsevier Inc
01.12.2017
Frontline Medical Communications Inc Elsevier Limited |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | The patient underwent initial laboratory studies, which revealed the following (reference ranges provided parenthetically): hemoglobin, 8.1 g/dL (12.0-15.5 g/dL); white blood cell count, 5.4 109/L (3.5-10.5 109/L), with a differential of 85% neutrophils and 9% lymphocytes; platelet count, 299 109/L (150-450 109/L); creatinine, 10.2 mg/dL (0.6-1.1 mg/dL); blood urea nitrogen, 36 mg/dL (8-24 mg/dL); brain natriuretic peptide, 1750 pg/mL (35 pg/mL); troponin, <0.01 ng/mL (0.0-0.1 ng/mL); sedimentation rate, 88 mm/h (0-22 mm/h); and C-reactive protein, 51.8 mg/L (8.0 mg/L). Acute pericarditis manifests in 4 phases on ECG: diffuse ST-segment elevation, resolution of ST-segment changes after several days, T-wave inversions, and normalization of ECG.3 Although ST-segment elevation is a hallmark of myocardial infarction, this change will be found only in the areas affected by ischemic disease. Which one of the following additional diagnostic tests is most likely to be useful for our patient? a. Serum double-stranded deoxyribonucleic acid (ds-DNA) b. Pericardiocentesis c. Interferon-gamma release assay d. Viral studies e. Magnetic resonance imaging (MRI) of the heart Anti-ds-DNA antibodies in the serum are highly specific for SLE, and the titer will vary on the basis of disease activity. Initial diagnostic work-up for all suspected pericarditis cases should include a complete blood cell count, erythrocyte sedimentation rate, measurement of serum C-reactive protein and cardiac biomarker levels, ECG, chest radiography, and echocardiography. |
---|---|
Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0025-6196 1942-5546 |
DOI: | 10.1016/j.mayocp.2017.02.022 |