Cardiology

Answer 2 Discharge home with echocardiography scheduled as an outpatient. This patient with pericarditis has no high-risk features, such as the presence of ventricular arrhythmias, hemodynamic compromise, cardiac tamponade, fever, an immunocompromised state, trauma, and chronic use of oral anticoagulants. Thus, outpatient follow-up with echocardiography would be the best choice.1 Because there is no clinical indication of cardiac tamponade or other high-risk features, CCU admission with immediate transthoracic echocardiography is not necessary. The etiology of the chest pain has been established, and no further diagnostic evaluation is necessary for alternative causes of chest pain, such as MI. In addition, active pericarditis is a contraindication to exercise stress testing. Laboratory testing rarely identifies an etiology of pericarditis and is not considered necessary unless the patient has additional signs or symptoms that suggest concomitant systemic illness, such as diseases of rheumatologic origin.1 REFERENCE 1. Lange RA, Hillis LD. Clinical practice. Acute pericarditis [published erratum appears in N Engl J Med 2005;352:1163]. N Engl J Med 2004;351:2195–202. Click here to return to the questions

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