Review Question - QID 100725

The clinical presentation is consistent with pericarditis with classic signs such as sharp pain in the chest, a friction rub, and a past medical history of SLE which often occurs with pericarditis.

Symptoms of acute pericarditis include pericardial friction rub, pleuritic chest pain, and fever. Pericarditis associated with SLE can be either serous or fibrinous. Etiologies of serous pericarditis include systemic lupus erythematosus (SLE), rheumatoid arthritis, viral illness, or uremic pericarditis. Etiologies of fibrinous pericarditis include SLE, myocardial infarction, and rheumatic fever.

Tingle et al. review the diagnosis and management of acute pericarditis. They emphasize that a history of abrupt-onset chest pain, the presence of a pericardial friction rub, and changes on electrocardiography suggest acute pericarditis, as do PR-segment depression and upwardly concave ST-segment elevation. Although highly specific for pericarditis, the pericardial friction rub is often absent or transient. Auscultation during end expiration with the patient sitting up and leaning forward increases the likelihood of observing this physical finding.

Ansari et al. review the cardiovascular manifestations of SLE. They report cardiovascular manifestations develop in the majority of SLE patients at some time during the course of their illness, the most common being acute pericarditis and pericardial effusion. They state that chronic adhesive pericarditis, pericardial tamponade, and constrictive pericarditis occur rarely.

Illustration A shows an electroocardiogram of acute pericarditis. Illustration V is a video that demonstrates the sound of a pericardial friction rub.

Incorrect Answers:
Answer 1: Pulmonary hypertension is not consistent with this case description. Rather, right-sided hypertrophy would be seen (on EKG) as well as jugular venous distension.
Answer 2: The clinical presentation is not consistent with interstitial lung disease.
Answer 3: The clinical presentation is not consistent with acute myocardial infarction.
Answer 5: Pericardial tamponade occur rarely in patients with SLE and would present with pulsus alternans on EKG, JVD with bilateral breath sounds.