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?
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?
💡 Explanation
**Core Concept**
Acute pericarditis is a clinical syndrome characterized by inflammation of the pericardium, often caused by viral infections. The clinical course and prognosis of acute pericarditis depend on several factors, but one key feature determines the patient's outcome.
**Why the Correct Answer is Right**
The correct answer is related to the presence of effusion. A pericardial effusion is a collection of fluid in the pericardial space, which can be detected by echocardiography. The presence of a large pericardial effusion is associated with a worse prognosis, including increased risk of cardiac tamponade, which can be life-threatening. In contrast, small effusions are often seen in viral pericarditis and have a good prognosis.
**Why Each Wrong Option is Incorrect**
**Option A:**
The presence of a pericardial rub is a diagnostic feature of acute pericarditis, but it does not determine the clinical course and prognosis.
**Option B:**
The absence of pulsus paradoxus is a good prognostic sign in cardiac tamponade, but it is not the feature that determines the patient's clinical course and prognosis in acute pericarditis.
**Option C:**
The presence of fever and myalgias is a nonspecific symptom of viral infections, including those that cause acute pericarditis. However, these symptoms do not determine the patient's clinical course and prognosis.
**Option D:**
The presence of a "flu" like illness one week prior to the onset of symptoms is a risk factor for developing acute pericarditis, but it does not determine the patient's clinical course and prognosis.
**Clinical Pearl / High-Yield Fact**
A pericardial effusion is a critical feature that determines the clinical course and prognosis of acute pericarditis. Remember to always evaluate for a pericardial effusion in patients with suspected acute pericarditis.
**Correct Answer:** D.
✓ Correct Answer: C. presence or nature of any underlying disease
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