skip to main content

Acute viral pericarditis — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

EasyCardiovascularAcute viral pericarditisABIM Board

A 34-year-old man has pleuritic chest pain that improves when he sits forward. He had a viral syndrome 1 week ago. Temperature is 37.8°C (100.0°F), blood pressure is 122/74 mm Hg, pulse is 96/min, and oxygen saturation is 98% on room air. ECG shows diffuse ST-segment elevation with PR-segment depression. Troponin is normal, and echocardiography shows no pericardial effusion. Which of the following is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Ibuprofen plus colchicine

This patient has uncomplicated acute pericarditis, supported by positional pleuritic chest pain and diffuse ST-segment elevation with PR depression after a viral illness. First-line treatment is an NSAID, such as ibuprofen, plus colchicine; colchicine improves symptom control and reduces recurrence. Normal troponin argues against associated myocarditis, and he has no high-risk feature such as temperature above 38°C, hemodynamic instability, or a large effusion. Urgent angiography is not indicated because the presentation and diffuse ECG abnormalities are not typical of an acute coronary occlusion. Corticosteroids are generally reserved for contraindication or failure of first-line therapy or a specific systemic indication. Pericardiocentesis is used for tamponade or selected significant effusions. Anticoagulation does not treat pericardial inflammation and has no indication here.

Reference: American College of Cardiology. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis, management section, 2025. https://www.acc.org/latest-in-cardiology/journal-scans/2025/08/05/19/05/new-concise-clinical