What's Your Diagnosis? Pericarditis and Myocarditis

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Emergency Department Management of Gastrointestinal Foreign Body Ingestion correct.

Case Presentation: Diagnosing and Treating Pericarditis and Myocarditis in the Emergency Department

A 30-year-old man, who is otherwise healthy, presents with chest pain that has been present and progressive for the last 3 days…

He reports having had a mild viral-like illness 1 week ago.
The patient appears mildly volume-overloaded on examination, with a temperature of 38.1°C, heart rate of 105 beats/min, blood pressure of 125/74 mm Hg, and oxygen saturation of 98%.
You suspect a viral syndrome but wonder whether a troponin and electrocardiogram are indicated…

Case Conclusion

Your patient felt improved following administration of acetaminophen. You ordered an ECG, which showed new, nonspecific T-wave inversions. His troponin was negative, his BNP was elevated, and a viral test for COVID-19 was positive. His chest x-ray showed pulmonary edema, and he responded to the initiation of 20 mg of IV furosemide. Using POCUS for bedside echocardiography, you did not see a pericardial effusion.

You admitted him for cardiac MRI and further treatment of suspected myocarditis, and recommended to his family that they receive their vaccinations, since the rate of vaccine-associated myocarditis is significantly less than that of COVID-19-induced myocarditis.

You told the patient that there was no contraindication for his receiving additional mRNA vaccination doses, according to the CDC, and if he elected to have additional doses, it should be administered after he had fully recovered from this acute illness.