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A 62-year-old man presents to the emergency room with 13 hours of sharp, retrosternal chest pain radiating to the back. The patient states that he had a myocardial infarction two weeks ago. He did not have symptoms of shortness of breath at that time. He is currently experiencing increased chest pain on deep inspiration, which did not occur before. He first began to experience the pain while lying down. On physical examination, the patient has a low-grade temperature of 100.9 F, a pulse of 91/min, blood pressure of 110/74 mm Hg, and respirations of 23/min. The EKG displays Mobitz type I second-degree heart block, ST elevation in leads I, II, III, aVF, aVL, and V1-V6, and depressed PR intervals. His past medical history is significant for congestive failure and asthma with multiple hospitalizations requiring intubation. Laboratory studies reveal: WBC 16,000/mm3, hematocrit 38.8%, platelets 339,000/mm3, erythrocyte sedimentation rate 130 mm/h. What is the best initial treatment for this patient's condition?

(A) Intravenous metoprolol or propranolol
(B) Thrombolytics and admit to CCU for monitoring
(C) Pacemaker
(D) Nonsteroidal antiinflammatory drugs (NSAIDs)
(E) Prednisone






D .




Answer: (D) Nonsteroidal antiinflammatory drugs (NSAIDs) Explanation: The patient described in this question presents with Dressler's syndrome, often referred to as post-cardiac injury syndrome. Dressler's syndrome can occur weeks to several months after myocardial infarction or open-heart surgery. It can be recurrent and is thought to represent an autoimmune syndrome or hypersensitivity reaction in which the antigen originates from injured myocardial tissue or pericardium. Circulating autoantibodies to myocardium frequently occur. Patients typically present with fever, pleuritic chest pain, leukocytosis, and an elevation


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