Substernal or left precordial pleuritic chest pain with radiation to the trapezius ridge (the bottom portion of scapula on the back) is the characteristic pain of<unk> . The pain is usually relieved by sitting up or bending forward, and worsened by lying down (both recumbent and supine positions) or by inspiration (taking a breath in). The pain may resemble that of angina but differs in that<unk>  pain changes with body position, where heart attack pain is generally constant and pressure-like. Other symptoms of<unk>  may include dry cough, fever, fatigue, and anxiety. Due to its similarity to the pain of myocardial infarction (heart attack),<unk>  can be misdiagnosed as a heart attack. Acute myocardial infarction can also cause<unk> , but the presenting symptoms often differ enough to warrant diagnosis. The following table organizes the clinical presentation of<unk>  differential to myocardial infarction: Characteristic<unk>  Myocardial infarction Pain description Sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain Crushing, pressure-like, heavy pain. Described as "elephant on the chest." Radiation Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation. Pain radiates to the jaw or left arm, or does not radiate. Exertion Does not change the pain Can increase the pain Position Pain is worse in the supine position or upon inspiration (breathing in) Not positional Onset/duration Sudden pain, that lasts for hours or sometimes days before a person comes to the ER Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the person decides to come to the ER Physical examinations The classic sign of<unk>  is a friction rub heard with a stethoscope on the cardiovascular examination, usually on the lower left sternal border. Other physical signs include a person in distress, positional chest pain, diaphoresis (excessive sweating); possibility of heart failure in form of pericardial tamponade causing pulsus paradoxus, and the Beck's triad of low blood pressure (due to decreased cardiac output), distant (muffled) heart sounds, and distension of the jugular vein (JVD). Complications<unk>  can progress to pericardial effusion and eventually cardiac tamponade. This can be seen in people who are experiencing the classic signs of<unk>  but then show signs of relief, and progress to show signs of cardiac tamponade which include decreased alertness and lethargy, pulsus paradoxus (decrease of at least 10 mmHg of the systolic blood pressure upon inspiration), low blood pressure (due to decreased cardiac index), (jugular vein distention from right sided heart failure and fluid overload), distant heart sounds on auscultation, and equilibration of all the diastolic blood pressures on cardiac catheterization due to the constriction of the pericardium by the fluid. In such cases of cardiac tamponade, EKG or Holter monitor will then depict electrical alternans indicating wobbling of the heart in the fluid filled pericardium, and the capillary refill might decrease, as well as severe vascular collapse and altered mental status due to hypoperfusion of body organs by a heart that can not pump out blood effectively. The diagnosis of tamponade can be confirmed with trans-thoracic echocardiography (TTE), which should show a large pericardial effusion and diastolic collapse of the right ventricle and right atrium. Chest X-ray usually shows an enlarged cardiac silhouette ("water bottle" appearance) and clear lungs. Pulmonary congestion is typically not seen because equalization of diastolic pressures constrains the pulmonary capillary wedge pressure to the intra-pericardial pressure (and all other diastolic pressures).
Pericarditis
Myocardial infarction
Carditis
Pleurisy
Myopericarditis
Precordial catch syndrome
Constrictive pericarditis
Myocarditis