pericarditis vs heart infraction diagnosis

[_expecto__]

Apart from the EKG, which is the best way to differentiate those two obviously, i've recently have seen a patient with pericarditis and he apparently felt more comfortable while sitting and leaning forward then laying down in bed, actually he didn't let us lay him down. On the other hand patient suffering from heart infarction felt better laying in bed/or felt no difference to sitting. Does anyone know why is that?

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[akuko2]

Most patients who have committed an infraction are nervous that the police may come and give them a ticket.

 

[takeurmeds02]

Honestly, EKG/port CXR after taking a good, focused H/P would probably give you the biggest bang for your buck and let you know how to proceed. More impending doom would be the MI; if no ischemic changes on EKG to suggest acute MI that needs immediate cath, then could start work up for other etiologies from there (labs, echo, etc) for ACS vs pericarditis or other.

Be curious to hear how others would work this up?

 

[_expecto__]

I've done some research and it's a real sign of pericarditis, this "not wanting to lay down and prefering leaning forward while sitting". pathophysiology of this sign is what really interests me.

 

[FindMeOnTheLinks]

a simple google search was very revealing as to why the pain in pericarditis is relieved with leaning forward

 

[_expecto__]

a simple google search was very revealing as to why the pain in pericarditis is relieved with leaning forward

I'm glad you're satisfied with what google search has to offer but i'm not. Could you share your revealing findings?

 

[mistafab]

Dude - these are very basic pathophys questions that google should suffice for. Get other people to help you with your homework! No way you are a med student.

I'm glad you're satisfied with what google search has to offer but i'm not. Could you share your revealing findings?

 

[ewax]

agree w above, pericarditis will show diffuse concave st elevations w pr depressions on ekg. STEMI will generally have a regional pattern of convex ("tombstone") st elevation.

 

[Boricua27]

is this for exam purposes or clinical? you give practically no HPI, which is key when talking about chest pain. for example is this a 66 year old, obese smoker with recent dyspnea upon exertion, who presents with typical chest pain? pericarditis would be very low on your differential.
for exams: "friction rub" sounds = pericarditis, which is often viral and not related to ischemia of the heart. he would feel better sitting up and leaning forward because it tugs less on the pericardium.