Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a recurrence of sharp, pleuritic retrosternal chest pain, typically relieved by sitting forward and worsened by recumbency. Symptoms follow a symptom-free interval of at least 4-6 weeks after the previous episode. Patient reports associated dyspnea, low-grade fever, and malaise. No signs of cardiac tamponade or hemodynamic instability.
Clinical Examination Findings
Cardiovascular exam reveals a characteristic pericardial friction rub, best heard at the left sternal border with the patient leaning forward. Heart sounds are distant if pericardial effusion is present. Jugular venous pressure (JVP) is assessed for elevation; lungs are clear to auscultation. No peripheral edema or signs of systemic inflammatory response noted.
Treatment Protocol
Initiate therapy with high-dose NSAIDs (e.g., Ibuprofen or Aspirin) combined with Colchicine as an adjunct to reduce recurrence rates. Taper NSAIDs only after complete resolution of symptoms and normalization of CRP. Consider corticosteroids only for refractory cases or contraindications to NSAIDs, with a very slow taper to prevent rebound inflammation.