A 28-year-old man with chest and joint pains.

MedStar author(s):
Citation: Heart. 102(10):808, 2016 May 15PMID: 26715568Institution: MedStar Washington Hospital CenterDepartment: Internal MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Arthralgia/mi [Microbiology] | *Chest Pain/mi [Microbiology] | *Rheumatic Heart Disease/mi [Microbiology] | Adult | Anti-Bacterial Agents/ad [Administration & Dosage] | Anti-Inflammatory Agents, Non-Steroidal/ad [Administration & Dosage] | Drug Administration Schedule | Humans | Magnetic Resonance Imaging, Cine | Male | Penicillins/ad [Administration & Dosage] | Pericardial Effusion/mi [Microbiology] | Rheumatic Heart Disease/dg [Diagnostic Imaging] | Rheumatic Heart Disease/dt [Drug Therapy] | Salicylates/ad [Administration & Dosage] | Time Factors | Treatment OutcomeYear: 2016Local holdings: Available online from MWHC library: 1939 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1355-6037
Name of journal: Heart (British Cardiac Society)Abstract: CLINICAL INTRODUCTION: A 28-year-old man with extensive travel history to developing countries was hospitalised for intermittent sharp chest pains, worst when supine and with inspiration. Two weeks prior to presentation, he had suffered a flu-like illness with a sore throat, which was resolving. Physical examination was notable for mild fever and tachycardia with cervical lymphadenopathy and painful bilateral knee and wrist effusions. Cardiac auscultation was remarkable for a soft early-peaking systolic murmur over the aortic area with a decrescendo early diastolic murmur along the left sternal edge. There was mild leucocytosis, elevation of serum troponin and acute-phase reactants with an ECG showing sinus tachycardia. Echocardiographic windows were extremely limited but suggested the presence of pericardial effusion and aortic regurgitation. Cardiac MRI was performed (figure 1). Viral, microbiological and autoimmune testing was remarkable only for significant elevation of antistreptolysin-O titres (1450 IU rising to 1940 IU, normal <200 IU). Pericardiocentesis revealed an exudative effusion, which was negative by cytology and microbiological analysis, including for tuberculosis and fungi.Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/QUESTION: The most appropriate next step is? Coronary angiographyEndomyocardial biopsyTreatment with colchicine for 3 monthsTreatment with corticosteroidsTreatment with high-dose salicylates and long-term penicillinFor the answer see page 808For the question see page 769.All authors: Ertel AW, Farzaneh-Far A, Romano SFiscal year: FY2016Digital Object Identifier: Date added to catalog: 2017-05-24
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 26715568 Available 26715568

Available online from MWHC library: 1939 - present, Available in print through MWHC library: 1996 - 2006

CLINICAL INTRODUCTION: A 28-year-old man with extensive travel history to developing countries was hospitalised for intermittent sharp chest pains, worst when supine and with inspiration. Two weeks prior to presentation, he had suffered a flu-like illness with a sore throat, which was resolving. Physical examination was notable for mild fever and tachycardia with cervical lymphadenopathy and painful bilateral knee and wrist effusions. Cardiac auscultation was remarkable for a soft early-peaking systolic murmur over the aortic area with a decrescendo early diastolic murmur along the left sternal edge. There was mild leucocytosis, elevation of serum troponin and acute-phase reactants with an ECG showing sinus tachycardia. Echocardiographic windows were extremely limited but suggested the presence of pericardial effusion and aortic regurgitation. Cardiac MRI was performed (figure 1). Viral, microbiological and autoimmune testing was remarkable only for significant elevation of antistreptolysin-O titres (1450 IU rising to 1940 IU, normal <200 IU). Pericardiocentesis revealed an exudative effusion, which was negative by cytology and microbiological analysis, including for tuberculosis and fungi.

Copyright Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

QUESTION: The most appropriate next step is? Coronary angiographyEndomyocardial biopsyTreatment with colchicine for 3 monthsTreatment with corticosteroidsTreatment with high-dose salicylates and long-term penicillinFor the answer see page 808For the question see page 769.

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