Chest Discomfort in a 71-Year-Old Woman – A Warning Sign of Acute Pericarditis

Acute pericarditis can strike unexpectedly, especially in older adults. This real-life case highlights the experience of a 71-year-old woman who came to the hospital with persistent chest discomfort and other alarming symptoms. Her journey through diagnosis and treatment offers valuable insights into recognizing and managing this condition effectively.

Understanding the Patient's Background

The patient was a 71-year-old woman with no prior history of hypertension or coronary artery disease. She visited the hospital after experiencing unexplained symptoms for a full week. The main issues she reported were chest pain, tightness, and shortness of breath—each occurring at night. She also had swelling in both legs and nausea, which did not improve on their own. Her condition eventually led her to seek medical attention at The First Affiliated Hospital of Xi'an Jiaotong University in June 2022.

Diagnosis and Treatment Plan

Upon examination, her lungs sounded clear, and there were no abnormal heart sounds or friction rubs. However, an ultrasound revealed a significant pericardial effusion—up to 3.4 cm in depth. An ECG showed sinus rhythm with T-wave abnormalities, leading to a diagnosis of acute pericarditis. Her treatment included a combination of oral medications: chloramphenicol, cefixime, and aspirin to manage infection and inflammation. She remained in the hospital for seven days and returned for a follow-up one week after discharge.

Initial Evaluation and Symptoms

During the first consultation, the patient described a week-long experience of chest pain, tightness, and difficulty breathing—mainly occurring at night. She also experienced leg swelling and nausea. With no history of major heart conditions and no self-medication, the physical exam was mostly unremarkable. However, the presence of significant pericardial fluid and abnormal T waves on the ECG confirmed the diagnosis of acute pericarditis, prompting immediate hospitalization.

Medical Treatment and Progress

Blood tests showed elevated white blood cell levels (10.79x10^9/L), indicating an ongoing infection. Based on this, the treatment plan focused on anti-inflammatory and antibiotic therapy. Chloramphenicol and cefixime were prescribed to control infection, while aspirin was added to reduce inflammation and relieve chest pain. The patient responded well to the treatment, showing steady improvement throughout her hospital stay.

Positive Recovery and Discharge

By the seventh day of treatment, all symptoms—including chest discomfort, shortness of breath, nausea, and leg swelling—had resolved completely. Her mental state was clear, and a follow-up blood test showed her white blood cell count had returned to normal (6x10^9/L). She was discharged with a follow-up appointment scheduled for one week later, during which no signs of recurrence were observed.

Post-Discharge Care and Recommendations

Before discharge, the patient was advised to prioritize rest and emotional well-being. A low-salt, low-fat diet was recommended to reduce cardiac strain, along with nutrient-rich foods such as high-protein and high-calcium options that are easy to digest. She was also reminded to maintain good lifestyle habits and continue her prescribed medications. If any severe side effects occurred, she was instructed to stop the medication and consult her doctor immediately.

Key Takeaways and Health Awareness

Chest pain and tightness are often dismissed as signs of fatigue or physical strain. However, as seen in this case, these symptoms can signal a serious condition like acute pericarditis. Early diagnosis and proper treatment are crucial for a full recovery. Regular health check-ups, a balanced lifestyle, and paying attention to unusual symptoms can make a significant difference in preventing complications and catching diseases early.