A 55-year-old man had an inferior STEMI treated with primary PCI 2 weeks ago. He now presents with fever of 38.2 degrees Celsius, pleuritic chest pain, and a pericardial friction rub. ESR is elevated at 55 mm/h. ECG shows diffuse ST elevation. Which is the most appropriate initial therapy?

• A Colchicine plus ibuprofen ✓
• B High-dose aspirin
• C Intravenous methylprednisolone
• D Broad-spectrum antibiotics

Explanation

This is acute post-MI pericarditis (Dressler syndrome is delayed autoimmune pericarditis occurring weeks to months later, but early pericarditis occurs within days). The 2-week presentation with pleuritic pain, friction rub, and fever is consistent with post-cardiac injury pericarditis. Treatment is NSAIDs plus colchicine. Steroids are reserved for refractory cases due to risk of impaired healing.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.