A 55-year-old man with anterior STEMI treated with primary PCI 4 days ago develops sudden severe pleuritic chest pain worsened by lying flat, low-grade fever, and a pericardial friction rub. ECG shows diffuse ST elevation and PR depression. Echocardiogram shows a small pericardial effusion. Which is the most likely diagnosis?

• A Ventricular free wall rupture
• B Reinfarction
• C Dressler syndrome
• D Early post-infarction pericarditis ✓

Explanation

Early post-infarction pericarditis occurs within the first 4 days of transmural MI, presenting with pleuritic pain, friction rub, and diffuse ST elevation with PR depression. Dressler syndrome is an autoimmune pericarditis occurring weeks to months after MI. Free wall rupture presents with sudden hemodynamic collapse and tamponade, not friction rub. Reinfarction would show localized ST changes and troponin rise, not diffuse pericarditis pattern.

Reference: Braunwald's Heart Disease, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.