A 28-year-old male presents with sharp retrosternal chest pain relieved by leaning forward. ECG reveals diffuse concave ST elevation with PR depression. What is the first-line therapy?
Answer and explanation
Correct answer: A. Colchicine plus ibuprofen
- Step 1: Pleuritic chest pain improving with forward leaning and diffuse concave ST elevations with PR depressions are diagnostic of acute pericarditis.
- Step 2: First-line treatment for acute viral or idiopathic pericarditis is a nonsteroidal anti-inflammatory drug combined with colchicine to reduce recurrence rates.
Answer
Colchicine plus ibuprofen.
Why not the others: Heparin anticoagulation is contraindicated in acute pericarditis due to the hazard of hemorrhagic pericardial effusion and cardiac tamponade. Systemic corticosteroids are second-line agents because they increase the rate of recurrent pericarditis. Nitroglycerin relieves ischemic angina but does not reduce pericardial inflammation.
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