Questions: An older male patient with advanced renal failure but not on dialysis, presents with a sharp pain in the chest with fever and dyspnea. The patient states that this pain worsens with deep breaths, coughing or swallowing. They have jugular venous distension present bilaterally. The heart sounds are muffled on auscultation but a friction rub is heard. The electrocardiogram shows an elevated ST segment in multiple leads, and the laboratory report shows an increase in the serum creatinine and blood urea nitrogen. Which diagnosis is most likely here? - Septic carditis - Pericarditis - Infective endocarditis - Myocarditis

An older male patient with advanced renal failure but not on dialysis, presents with a sharp pain in the chest with fever and dyspnea. The patient states that this pain worsens with deep breaths, coughing or swallowing. They have jugular venous distension present bilaterally. The heart sounds are muffled on auscultation but a friction rub is heard. The electrocardiogram shows an elevated ST segment in multiple leads, and the laboratory report shows an increase in the serum creatinine and blood urea nitrogen. Which diagnosis is most likely here?
- Septic carditis
- Pericarditis
- Infective endocarditis
- Myocarditis
Transcript text: Quiz Exam 2 360e south.edu/courses/49691/quizzes/275452/take Question 13 1 pts An older male patient with advanced renal failure but not on dialysis, presents with a sharp pain in the chest with fever and dyspnea. The patient states that this pain worsens with deep breaths, coughing or swallowing. They have jugular venous distension present bilaterally. The heart sounds are muffled on auscultation but a friction rub is heard. The electrocardiogram shows an elevated ST segment in multiple leads, and the laboratory report shows an increase in the serum creatinine and blood urea nitrogen. Which diagnosis is most likely here? Septic carditis Pericarditis Infective endocarditis Myocarditis
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Solution

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The answer is the second one: Pericarditis.

Explanation for each option:

  1. Septic carditis: This condition, also known as infective endocarditis, typically involves infection of the heart valves and is characterized by symptoms such as fever, heart murmurs, and positive blood cultures. The presence of a friction rub and the specific symptoms described (chest pain worsening with deep breaths, coughing, or swallowing) are more indicative of pericarditis rather than septic carditis.

  2. Pericarditis: This is the correct diagnosis. The symptoms described, including sharp chest pain that worsens with deep breaths, coughing, or swallowing, are classic for pericarditis. The presence of a friction rub, elevated ST segments in multiple leads on the ECG, and the patient's renal failure (which can lead to uremic pericarditis) all support this diagnosis.

  3. Infective endocarditis: This condition involves infection of the heart valves and is usually associated with symptoms like fever, heart murmurs, and positive blood cultures. The presence of a friction rub and the specific symptoms described are more indicative of pericarditis.

  4. Myocarditis: This condition involves inflammation of the heart muscle and can present with symptoms like chest pain, heart failure, or arrhythmias. However, the presence of a friction rub and the specific symptoms described are more indicative of pericarditis.

In summary, the symptoms and clinical findings are most consistent with pericarditis, particularly uremic pericarditis due to the patient's advanced renal failure.

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