Question: 32 year old man presents to the GP with a 2 day history of dyspnoea and retrosternal chest pain, which came on gradually. The patient cannot recall any trauma or abnormal exertion. He has a history of progressive chronic renal failure. The pain is stabbing in quality, radiates to the neck and left shoulder, is relieved by sitting upright and made worse by lying fat and coughing.
- A. Pericarditis
- B. Myocardial infarction
- C. Unstable angina
- D. Pulmonary embolism
A. Pericarditis-hallmark: pain is positional; pain worse on lying flat and relieved by sitting forwards. Pericarditis can occur at about day 2 or 3 after a transmural myocardial infarct as an inflammatory response to the necrotic heart muscle.
Pericarditis tends to cause a sharp pain which is variable in site/intensity.-
B. Myocardial infarction- diffuse & severe chest pain centrally located, radiating to the left arm -
C. Unstable angina- angina occurring at rest-
D. Pulmonary embolism- unlikely because no history of immobilisation, stress or stasis that suggest a DVT