A 42-year-old woman suffering from systemic lupus erythematosus was admitted to the hospital with substernal, nonradiating pain that awakened her from sleep. Physical examination showed a patient in moderate distress, complaining of chest pain that got worse by thoracic motion. Vital signs included temperature 103F, pulse 90 BPM, blood pressure 150/90 mm Hg, respirations 18/min. Auscultation revealed a precordial systolic and diastolic friction rub. Which of the following drug classes would be absolutely contraindicated for this patient?
Learning objective: describe the main contraindications of fibrinolytic drugs. Answer: B
The symptoms and signs of the patient suggest that she is mos likely suffering from acute pericarditis. In the current era of thrombolytic therapy for acute coronary occlusion the distinction between myocardial infarction and acute pericarditis is crucial. If pericarditis is misdiagnosed as myocardial infarction, thrombolytic drugs may cause pericardial hemorrhage and cardiac tamponade. Usually pericardial pain can be distinguished from ischemic coronary pain because the latter is not aggravated by chest motion. When present, a precordial friction rub is diagnostic, like in the present case.
Pericarditis may be caused by inflammation, trauma or neoplasm. Sometimes it accompanies systemic diseases, like in the present case. Most often, however, the etiology of acute pericarditis cannot be identified and is referred to as idiopathic.
A, C) Anti-inflammatory drugs are used to relieve inflammation and pain of acute pericarditis.
D) If pain does not subside with anti-inflammatory drugs, opioids can be used.
E) Antibiotics are employed when pericarditis is due to bacterial infection (most commonly