A 29-year-old female presents with sudden sharp chest pain that is relieved by sitting upright and leaning forward, and worsened by lying supine or coughing. ECG shows diffuse, concave ST-segment elevations across all precordial and limb leads, accompanied by PR-segment depression in lead II and PR-segment elevation in lead aVR. What is the diagnosis?

Answer and explanation

Correct answer: A. Acute pericarditis

  1. Step 1: The pathognomonic clinical presentation of acute pericarditis includes positional pleuritic chest pain relieved by leaning forward and characteristic diffuse, widespread concave ST-segment elevations with reciprocal PR depression in lead II and PR elevation in aVR.
  2. Step 2: Consequently, the correct clinical answer is Acute pericarditis.
Answer
Acute pericarditis.
Why not the others: 'Acute anterior myocardial infarction' produces localized, convex ('tombstone') ST elevations confined to vascular territories (V1-V4) with reciprocal ST depressions in inferior leads; 'Costochondritis' produces localized parasternal chest wall tenderness without ECG repolarization abnormalities; 'Aortic dissection' presents with severe tearing back pain.

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