Thank you to Dr. Ho-Ping Kong for hosting today’s morning report, and thank you to team 7 for bringing the case.
Today we discussed a case with a man (in his 40’s) who presented with pleuritic chest pain. We discussed the differential diagnosis of pleuritic chest pain that gets worse when lying down and improves with sitting up: pulmonary embolism, pneumonia, pericarditis. Also, given the nature of his pain, pancreatitis and GERD can sometimes have these symptoms, too. This patient also had a history of upper respiratory tract infection few weeks prior. ECG showed changes compatible with pericarditis (with negative troponin). These changes may include diffuse ST elevation that is concave up (except for V1 and aVR) and PR segment depression.
We attributed his pericarditis to a viral illness. One of the common viral causes is coxsackie virus (although we really cannot prove this). We also discussed other causes of pericarditis include: infection (viral, bacterial, TB, rarely fungal), transmural MI, after CABG, connective tissue disease (e.g. lupus), uremia, drugs, chest wall radiation, chest wall trauma, and neoplastic disease.
As always, we also learned some medical trivia along the way. Banting and Best treated their first patient with insulin at Toronto General Hospital, it was a patient from the United States. When someone has pneumonia and GI symptoms (e.g. diarrhea), it is important to consider Legionella as a causative organism.
You can find out more about ECG changes of pericarditis at ECG Made Simple (linked here). It is a very good resource for learning many things about ECG. You can also read more about pericarditis in this article (linked here).
Thank you everyone for a great month! I have thoroughly enjoyed working with all of you. Chris Smith will be back Monday.