A 58-year-old woman with anterior STEMI undergoes primary PCI to the LAD. Day 3, she develops low-grade fever, pleuritic chest pain, and diffuse saddle-shaped ST elevation without reciprocal changes. Echo shows a small pericardial effusion with no hemodynamic compromise. What is the correct treatment?
- A Colchicine 0.5 mg twice daily for 3 months
- B Ibuprofen 600 mg three times daily
- C Prednisone 1 mg/kg/day
- D High-dose aspirin 650 mg four times daily ✓
Explanation
Early post-MI pericarditis (occurring within the first week, Dressler's syndrome occurs 2–10 weeks later) is treated with high-dose aspirin (aspirin 650 mg every 4–6 hours) as aspirin is the preferred NSAID in post-MI pericarditis because it does not impair myocardial healing or coronary vasoconstriction, unlike ibuprofen and other NSAIDs. Colchicine is added in some protocols. Corticosteroids are avoided as they impair scar formation and increase recurrence risk. Current ESC pericarditis guidelines specifically recommend aspirin over other NSAIDs in the post-MI setting.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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