Diagnosis:
-H&P
-Echo, CXR, EKG (Diffuse ST elevations, PR depressions)
-CBC, CMP,
-Troponins, CRP, ESR.
-Consider ordering antiviral/antibacterial/anti-
-Check flu, HIV. TB if risk factors.
-DDx and Etiologies.
Treatment:
-Consult cardiology
-Colchicine 0.6 mg daily
-Ibuprofen 600 mg q8h
-Pantoprazole 40 mg daily (prevention of GI toxicity from NSAIDs)
-Recheck echo in 2-3 days.
-Recheck CRP in one week.
PRN: Ondansetron for n/v; Tramadol for pain; Tylenol for pain.
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Treat empirically with colchicine and/or NSAIDs.
Glucocorticoids – Reserve for severe or refractory cases.
Reciprocal ST-segment depressions (in leads besides aVR) can help to distinguish between an MI and Pericarditis. Reciprocal ST-segment changes shout not be seen in patients with pericarditis. If you see this ECG finding, it’s best to assume it’s an MI.
Reference
Snyder MJ, Bepko J, White M: Acute pericarditis: Diagnosis and management. Am Fam Physician 2014;89(7):553-560. http://www.aafp.org/afp/2014/0401/p553.html