SHM Converge Scientific Abstract ePoster Gallery-Pericarditis Presenting as Acute Symptomatic Bradycardia

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This case report describes a 21-year-old man with no prior medical history who presented with sudden substernal, pleuritic chest pain, palpitations, hypotension, and marked sinus bradycardia. He appeared diaphoretic and had shallow breathing, but initial CT angiography of the chest, abdomen, and pelvis showed no acute pathology. Early labs were largely unrevealing, with low inflammatory markers and only mildly elevated troponin; HIV testing was negative. Initial ECG showed sinus bradycardia with sinus arrhythmia.<br /><br />Because of persistent hypotension, he was started on norepinephrine and admitted to the cardiac ICU. Transthoracic echocardiogram showed normal cardiac function, preserved LVEF (57%), and no pericardial effusion. He was weaned off pressors and treated empirically with ibuprofen and famotidine. Blood cultures remained negative.<br /><br />By 36–48 hours after presentation, repeat ECG showed diffuse ST-segment elevation, and inflammatory markers rose significantly (ESR and CRP increased markedly). Cardiology confirmed acute viral pericarditis and initiated colchicine. He was discharged after 48 hours on a 3-month course of colchicine, a 3-week course of ibuprofen, and outpatient cardiology follow-up.<br /><br />The report highlights that acute pericarditis can rarely present with bradycardia and hypotension rather than the more typical tachycardia, and that ECG changes and inflammatory markers may be delayed early in the disease course. Serial testing can therefore be important when initial findings are nondiagnostic.

Asset Subtitle

Maria Ruiz

Meta Tag

Author List Khanh T. Nguyen, Maria Ruiz

Category Clinical Vignettes

Concept Acute Pericarditis

Concept Bradycardia

Concept Hypotension

Concept Electrocardiogram

Concept Transthoracic Echocardiography

Distinguished Non-Finalist

Presenter Organization The University of Chicago Pritzker School of Medicine

Presenting Author Maria Ruiz

Track Adult

Keywords

acute pericarditis

sinus bradycardia

hypotension

diffuse ST-segment elevation

viral pericarditis

chest pain

colchicine

ibuprofen

inflammatory markers

serial ECG monitoring

Acute Pericarditis

Bradycardia

Hypotension

Electrocardiogram

Transthoracic Echocardiography