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Pericarditis — MCCQE Part 1 MCQ

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ModerateChest PainPericarditisMCCQE Part 1

28-year-old man after a viral illness presents with sharp chest pain worse when supine and improved by sitting forward. ECG shows diffuse ST elevation and PR depression; troponin is minimally elevated. Which of the following is the most appropriate next step?

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Correct answer: E — Treat with NSAID plus colchicine after assessing for high-risk features

Treat with NSAID plus colchicine after assessing for high-risk features is best because the positional pain and diffuse ECG changes are classic for acute pericarditis without tamponade. Discharge after a single normal initial test is suboptimal because early cardiac disease can be missed by one isolated result; Arrange routine cardiology review without acute risk stratification is suboptimal because routine referral is too slow for a potentially unstable presentation; Give reassurance because the patient is young or previously well is suboptimal because age alone does not exclude serious cardiovascular disease; Treat only the symptom and omit ECG or biomarker-based assessment is suboptimal because cardiac presentations require objective assessment when suggested clinically. Pericarditis is clinical and ECG-led; tamponade features change the urgency.

Reference: CCS pericardial disease guidance