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APA
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Health, Medicine, Nursing
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English (U.S.)
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Topic:

Different Diagnoses Related to Pericarditis

Coursework Instructions:

Based on the following information, create a list of three differential diagnoses and explain why you would include them on your list.
History
C.R., a 34-year-old man, came to your clinic with an episode of chest pain. He has a previous history of occasional stabbing chest pain for 2 years. The current pain had come on 4 hours earlier at 8 p.m. and has been persistent since then. It is central in position, with some radiation to both sides of the chest. It is not associated with shortness of breath or palpitations. The pain is relieved by sitting up and leaning forward. Two Tylenol tablets taken earlier at 9 p.m. did not make any difference to the pain.
The previous chest pain had been occasional, lasting a second or two at a time and with no particular precipitating factors. It has usually been on the left side of the chest although the position has varied.
Two weeks previously he had mild to moderate symptoms of COVID-19 which lasted 14 days. This consisted of a sore throat, low-grade fever, loss of taste and smell, and a cough. His wife and two children were ill at the same time with similar symptoms but have been well since then. He has a history of migraines. In the family history, his father had a myocardial infarction at the age of 51 years and was found to have a marginally high cholesterol level. His mother and two sisters, aged 36 and 38 years, are well. After his father's infarct, he had his lipids measured; the cholesterol was 5.1 mmol/L (desirable range < 5.5 mmol/L). He is a nonsmoker who drinks two 12-packs of beer per week.
Examination
His pulse rate is 75/min, blood pressure 124/78 mmHg. His temperature is 37.8C. There is nothing abnormal to find in the cardiovascular and respiratory systems. The ECG findings include diffuse concave-upward ST-segment elevation and, occasionally, PR-segment depression.

Coursework Sample Content Preview:

T16 DQ2
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T16 DQ2
1 Pericarditis from myocardial infarction
The patient, C.R., has reported having prior chest aches that lasted between one to two seconds. However, cardiac discomfort, like practically any other serious pain, lasted much longer, and acute left-sided chest pains are extremely prevalent. Pericarditis frequently causes cardiac inflammation (MayoClinic, 2022), which could account for increased creatine kinase. Pericarditis can be a complication of myocardial infarction. However, it usually happens a day or more later, either as inflammation directly resulting from the underlying heart muscle's death or as an immunological. Pericarditis can also be caused by a variety of connective tissue problems and arteritides, TB, and other local infections or tumors.
2 Pericarditis from viral infection
His family history provides the risk of ischemic heart disease, but the history and examination reveal no other risk factors. Pain that originates in the pericardium is relieved by sitting up and leaning forward. The account of a recent upper respiratory tract infection related to COVID shows that this is most likely a viral infection. Coxsackie B viruses are the most common cause of pericarditis (Low et al., 2012). Pericarditis is included because pericarditis cannot be ruled out simply because there is no pericardial irritation. Rubs come in a variety of intensities and are not always audible. If this diagnosis is suspected, it is typically worth repeating...
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