Which combination best describes the typical presentation of acute pericarditis?

Which combination best describes the typical presentation of acute pericarditis?

• A. Pain relieved by lying down; ST elevations in all precordial leads; elevated enzymes
• B. Pain improves when sitting up and leaning forward; diffuse ST elevations on ECG; normal cardiac enzymes
• C. Pain worsens with inspiration; ST elevations only in inferior leads; elevated troponin
• D. Pain worsens with exertion; ST depressions; abnormal enzymes

Answer: (B)

Acute pericarditis typically presents with sharp, pleuritic chest pain that worsens with inspiration and lying flat, and improves when the patient sits up and leans forward. The ECG characteristically shows diffuse ST-segment elevations across many leads, often with PR-segment depressions. Cardiac enzymes, such as troponin, are usually normal because there is no myocardial necrosis in pure pericarditis (myopericarditis may elevate enzymes, but the classic picture remains normal enzymes). Putting that together, the description of pain relief by sitting up and leaning forward, diffuse ST elevations, and normal enzymes is the best match for acute pericarditis. In contrast, pain relief from lying down, focal or limited ST elevations, or elevated troponin would point toward different problems such as myocardial infarction or myopericarditis.

Acute pericarditis typically presents with sharp, pleuritic chest pain that worsens with inspiration and lying flat, and improves when the patient sits up and leans forward. The ECG characteristically shows diffuse ST-segment elevations across many leads, often with PR-segment depressions. Cardiac enzymes, such as troponin, are usually normal because there is no myocardial necrosis in pure pericarditis (myopericarditis may elevate enzymes, but the classic picture remains normal enzymes). Putting that together, the description of pain relief by sitting up and leaning forward, diffuse ST elevations, and normal enzymes is the best match for acute pericarditis. In contrast, pain relief from lying down, focal or limited ST elevations, or elevated troponin would point toward different problems such as myocardial infarction or myopericarditis.