A 45 year old male smoker presented with chest pain radiating to neck

A  45 year old male smoker presented with chest pain radiating to neck and left shoulder for last 7 days. Examination was significant for resting tachycardia and pericardial friction rub with clear lung fields. ECG showed sinus tachycardia, diffuse ST elevation in all leads except aVR, V1. Troponins were modestly elevated. CBC, ESR, ANA, TFTs, all were normal.

a)      What is the diagnosis (complete diagnosis)

b)      What is the cause of troponin elevation

c)      Would you consider colchicine? If yes then give reason

d)      What are echo Doppler findings of constrictive pericarditis

e)      What is Becks traid

Answers:

a.      Acute MyoPericarditis

b.      Myocardial Involvement

c.       Yes, it reduces risk of recurrence, COPE Trial

d.       

2D findings:

• Septal bounce
• Ventricular interdependence
• IVC Plethora

Doppler Findings:

• Respiratory variation in mitral and tricuspid flows: In mitral valve inflow peak E velocity decreases by 33% or greater. In tricuspid valve inflow peak E velocity increases by 44% or greater and peak A velocity increases by 38% or greater. 
• Pulmonary systolic/diastolic (S/D) flow ratio is decreased 
• Respiratory variation in hepatic vein flow

e.      Muffled heart sounds, Hypotension and raised JVP

Reference:

1. Chapter 40, page 647, 656 – Acute Pericarditis - Manual of Cardiovascular Medicine Fourth Edition - Brian P. Griffin MD FACC
2. Imazio Massimo, Bobbio Marco, Cecchi Enrico, Demarie Daniela, Demichelis Brunella, Pomari Franco, Moratti Mauro, Gaschino Gianni, Giammaria Massimo, Ghisio Aldo, Belli Riccardo, Trinchero Rita. Colchicine in addition to conventional therapy for acute pericarditis: results of the COlchicine for acute PEricarditis (COPE) trial. Circulation. 2005 Sep 27;112 (13):2012–6. [PubMed]