24-Year-Old Man With Acute Chest Pain

• Published in: Mayo Clinic proceedings Vol. 92; no. 12; pp. 1850 - 1854
• Main Authors: Trautman, Christopher L., Villanueva, Armando, Stancampiano, Fernando F.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.12.2017; Frontline Medical Communications Inc; Elsevier Limited
• Subjects: Acute coronary syndromes; Acute Disease; Arthritis; Blood; Cardiac arrhythmia; Cardiomyopathy; Care and treatment; Case studies; Chest pain; Chest Pain - etiology; Cocaine; Diagnosis; Diagnosis, Differential; Dyspnea; Dyspnea - etiology; Electrocardiography; Embolisms; Erythrocyte sedimentation rate; Family medical history; Heart attacks; Humans; Ischemia; Laboratories; Lupus; Male; Pain; Patients; Pericarditis; Pericarditis - diagnosis; Peritoneal dialysis; Pulmonary arteries; Systematic review; Thoracic surgery; Young Adult
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2017.02.022

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.