A 40-year-old male is experiencing sudden onset of sharp, stabbing chest pain that worsens with deep breaths and coughing. He denies any radiating pain or associated symptoms like nausea or dizziness. He reports a recent history of a viral illness. His vital signs are: BP 120/80 mmHg, HR 90 bpm, RR 24 breaths/min, SpO2 98% on room air. Lung sounds are clear bilaterally. What is the MOST likely cause of his chest pain?
- AAcute Myocardial Infarction (AMI)
- BAortic Dissection
- CPulmonary Embolism
- DPericarditis
Show answer & explanationAnswer & explanation
Correct answer: D. Pericarditis
The patient's symptoms of sharp, stabbing chest pain that worsens with deep breaths (pleuritic pain) and coughing, without radiating pain or other cardiac symptoms, following a viral illness, are highly characteristic of pericarditis. AMI typically presents with crushing, radiating pain; aortic dissection with tearing pain and unequal pulses/BP; and pulmonary embolism with sudden dyspnea and pleuritic chest pain, but often with hypoxemia and tachycardia.
Why the other options are wrong
- A. AMI pain is typically crushing, substernal, radiating, and not usually pleuritic.
- B. Aortic dissection typically presents with sudden, severe, tearing pain and often unequal pulses/blood pressures.
- C. While pulmonary embolism can cause pleuritic pain, it is often associated with sudden dyspnea, hypoxemia, and tachycardia, which are not prominent here.
Pericarditis Recognition
Pericarditis is inflammation of the pericardium, often causing sharp, pleuritic chest pain that may be relieved by leaning forward and worsened by deep breaths/coughing, often preceded by a viral illness.
- Pleuritic chest pain is a key feature.
- Pain often improves when leaning forward.
- Often follows a viral infection.
Memory trick: Sharp pain with every breath, after a bug, think 'Pericarditis is rough!'