A 20-year-old woman with no known past medical history, presents with acute chest pain for 3 hours. On physical examination, her body temperature was 38.2 C. An EKG is performed as shown below. High-sensitivity Troponin-T negative, and CRP is elevated. 

Which of the following statement is correct? 

1. The most likely diagnosis is acute coronary syndrome.
2. Fever with body temperature >38 C, is considered a high-risk feature.
3. The patient should be managed as outpatient.
4. Steroid is the treatment of choice.
5. The patient shold restrict physical activity for 6 months.

โดย ร.ท.ธีรเวชช์  แพทยานันท์ อาจารย์หน่วยอายุรศาสตร์โรคหัวใจและหลอดเลือด กองอายุรกรรม โรงพยาบาลภูมิพลอดุลยเดช กรมแพทย์ทหารอากาศ

ANSWERs

Following 2025 ESC Guidelines for the management of myocarditis and pericarditis, the correct answer is B. Fever with body temperature >38 C, is considered a high-risk feature.

Explanation: 

1. The most likely diagnosis is acute coronary syndrome. (Incorrect)

• This patient is young and has no atherosclerotic risk factors. EKG shows diffuse ST-segment elevation with PR-segment depression. The most likely diagnosis is acute pericarditis.

3. This patient should be managed as outpatient. (Incorrect)

• Outpatient management is appropriate only in the absence of high-risk features. Because this patient has fever, BT >38 C, she should be admitted for inpatient management.

4. Steroid is the treatment of choice. (Incorrect)

• First line therapy of acute pericarditis is high-dose aspirin or NSAIDs in combination with colchicine. Steroid are reserved for refractory cases or when NSAIDs/colchicine are contraindicated.

5. This patient should restrict physical activity for 6 months. (Incorrect)

• Patients with acute pericarditis should restrict physical activity for at least 1 month, until complete resolution of symptoms and normalization of inflammatory markers

โดย ร.ท.ธีรเวชช์  แพทยานันท์ อาจารย์หน่วยอายุรศาสตร์โรคหัวใจและหลอดเลือด กองอายุรกรรม โรงพยาบาลภูมิพลอดุลยเดช กรมแพทย์ทหารอากาศ