A 22-year-old woman presents to the office with symptoms of sharp chest pain that is made worse with lying down especially on her left side. One week prior to the onset of symptoms she had "flu" like illness with fevers, chills, and myalgias. Her past medical history is negative and she is not taking any medications.On physical examination, the blood pressure is 130/80 mm Hg with no pulsus paradoxus, and heart rate 100/min. The heart sounds are normal but there is a pericardial rub heard best at the apex in the left lateral decubitus position, the lungs are clear and there is no peripheral edema. Which of the following features determines the patient's clinical course and prognosis?