Acute Mi

ST-segment elevation

Diffuse: in limb leads as well as V2-V6

Regional (vascular territory), e.g., inferior, anterior, or lateral

PR-segment depression

Present

Usually absent

Reciprocal ST-segment depression

Absent

Typical, e.g., ST-segment depression interiorly with anterior ischemia (ST elevation)

QRS complex changes

Absent

Loss of R-wave amplitude and development of Q waves

make the distinction (Table 18-2). Also, if the ECG reveals arrhythmias or conduction abnormalities, the condition is much more likely to represent ischemia rather than pericarditis.

Most patients with acute viral or idiopathic pericarditis have excellent prognoses. Treatment is mainly based on symptoms, with aspirin or another nonsteroidal antiinflammatory drug (NSAID), such as indomethacin. for relief of chest pain. Some physicians favor ibuprofen with colchicine, and use of corticosteroids for refractory symptoms. In most patients, symptoms typically resolve within days to 2-3 weeks. Any form of pericarditis can cause pericardial effusion and bleeding: however, the most serious consequence would be cardiac tamponade. It is a common misconception that a pericardial friction rub cannot coexist with an effusion (this is very common in uremic pericarditis). Therefore, it is important to monitor these patients for signs of developing hemodynamic compromises, such as cardiac tamponade.

Our patient is very young and has no significant previous medical history. The presence of symmetric arthritis as well as laboratory findings suggest a systemic disease, such as SLE, as the cause of her pericarditis. SLE is a systemic inflammatory disease that mainly affects women. It is characterized by autoimmune multiorgan involvement, such as pericarditis, nephritis, pleuritis, arthritis, and skin disorders. To diagnose SLE, the patient must meet four of the 11 criteria listed in Table 18-3 (96% sensitive and 96% specific).

Table 18-3

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