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Recurrent acute pericarditis — ABIM Board MCQ

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ModerateCardiovascularRecurrent acute pericarditisABIM Board

A 42-year-old woman has pleuritic chest pain that improves when leaning forward. ECG shows diffuse concave ST elevation and PR depression. Troponin is minimally elevated, LVEF is normal, and there is no effusion. Two weeks later, pain recurs after she stopped ibuprofen early. Which of the following is the most likely cause?

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Correct answer: E — Undertreated acute pericardial inflammation

Typical pericarditic chest pain with diffuse ST elevation and PR depression indicates acute pericarditis. Recurrence is promoted by inadequate anti-inflammatory treatment or lack of colchicine, assuming myocarditis and infection are not suggested.

Reference: 2015 ESC Pericardial Disease Guideline; ACC Pericarditis Review