A 62-year-old man 2 weeks after an inferior STEMI presents with positional chest pain relieved by sitting forward, low-grade fever, and a pericardial friction rub. ECG shows diffuse PR depression and ST elevation. Troponin is stable and not rising. What is the most appropriate management?

• A Systemic corticosteroids
• B Emergency pericardiocentesis
• C Intravenous antibiotics
• D High-dose aspirin ✓

Explanation

This is early post-infarction pericarditis, occurring within days to weeks of MI, distinct from Dressler syndrome which occurs weeks to months later. Treatment is high-dose aspirin (750 mg every 8 hours), which is preferred over NSAIDs because NSAIDs and corticosteroids impair infarct healing. Ibuprofen is contraindicated post-MI. Pericardiocentesis is not needed as there is no tamponade. Antibiotics are not indicated as this is an inflammatory, not infectious, process.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.