A 78-year-old man with mild dementia is hospitalized due to chest discomfort, breathing difficulty, and agitation. He was initially diagnosed with an acute exacerbation of chronic obstructive pulmonary disease, but he was later found to have had an acute myocardial infarction. The patient gets confused in the evening and refuses medications. On the third day of hospitalization, he has sharp chest pain and does not want to lie down. A friction rub is heard along the left sternal border. Which of the following would have most likely prevented this patient's current condition?

Question

A 78-year-old man with mild dementia is hospitalized due to chest discomfort, breathing difficulty, and agitation.  He was initially diagnosed with an acute exacerbation of chronic obstructive pulmonary disease, but he was later found to have had an acute myocardial infarction.  The patient gets confused in the evening and refuses medications.  On the third day of hospitalization, he has sharp chest pain and does not want to lie down.  A friction rub is heard along the left sternal border.  Which of the following would have most likely prevented this patient's current condition?

Quizplus · Accepted Answer

11ec25c8_d32c_d450_bc81_7147b06f60d4_MD0003_00 This patient with sharp chest pain that began within 2-4 days following a myocardial infarction (MI) likely has peri-infarction pericarditis (PIP). PIP results from localized inflammation triggered by transmural myocardial necrosis following ST-elevation MI, and it is best prevented by early coronary reperfusion therapy, which helps minimize myocardial necrosis. Treatment is usually supportive, but high-dose aspirin is sometimes given to alleviate severe inflammation and pain. Corticosteroids and nonsteroidal anti-inflammatory drugs other than aspirin (eg, ibuprofen) are avoided due to impairment of collagen deposition and a potential increased risk of free wall rupture. Postcardiac injury pericarditis (Dressler syndrome) is differentiated from PIP in that it results from the production of antibodies to myocardial antigens and occurs 1 week to several months following MI. In addition, postcardiac injury pericarditis typically involves diffuse, rather than localized, pericardial involvement. (Choice A) Antibiotic prophylaxis to prevent endocarditis is indicated prior to dental procedures in patients with high-risk cardiac conditions (eg, prosthetic heart valve). (Choices B and E) Both anticoagulation with heparin and beta blocker therapy are used to treat acute MI. Although anticoagulation helps prevent further thrombosis, it does not restore perfusion to lower the risk of PIP. Beta blockers reduce myocardial oxygen demand by lowering the heart rate and myocardial contractility; however, their benefit in preventing PIP is likely minimal. (Choice D) Early mobilization helps reduce the risk of lower extremity deep venous thrombosis in postsurgical patients, but it likely has no effect on the risk of developing PIP. Educational objective: Peri-infarction pericarditis (PIP) results from localized inflammation triggered by myocardial necrosis and can occur 2-4 days following transmural myocardial infarction. PIP is best prevented by early coronary reperfusion therapy to minimize the extent of myocardial necrosis.

A 78-Year-Old Man with Mild Dementia Is Hospitalized Due to Chest