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.
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