33-Year-Old Man Experiences Recurrent Chest Pain Due to Acute Pericarditis

Acute pericarditis is often overlooked or misdiagnosed, especially when symptoms appear gradually or are mistaken for other conditions. In this case, a 33-year-old male experienced recurring chest pain and shortness of breath for two months before receiving the correct diagnosis. Initially, he self-medicated without consulting a doctor, which delayed proper treatment. His condition worsened significantly the day before his hospital visit, prompting him to seek medical attention. After a thorough examination, including an echocardiogram, he was diagnosed with acute pericarditis and successfully treated with a combination of anti-inflammatory and antitubercular medications.

Key Information

Patient: Male, 33 years oldDiagnosis: Tuberculous Pericarditis (a form of acute pericarditis)Hospital: First Affiliated Hospital of Xi'an Jiaotong UniversityAdmission Date: May 2022Treatment: Oral administration of Indomethacin, Isoniazid, Ethambutol Hydrochloride, and RifampicinDuration of Treatment: 8 days of in-hospital care with follow-up as neededOutcome: Complete resolution of chest pain, shortness of breath, and dry cough

Initial Consultation and Symptoms

During the first consultation, the patient reported experiencing sudden chest pain and shortness of breath two months earlier, especially after physical activity. He noted that symptoms would subside with rest but would return with exertion. He could barely walk 500 meters or climb two flights of stairs without discomfort. Additionally, he had a persistent dry cough at night. He denied having fever, headache, dizziness, or any history of chronic illnesses such as hypertension or diabetes. Upon physical examination, doctors observed coarse breath sounds in both lungs, with diminished breath sounds in the right lung. No pericardial friction rub or heart murmurs were detected. An echocardiogram revealed global cardiac enlargement and pericardial effusion, leading to a diagnosis of acute pericarditis.

Diagnostic Findings and Treatment Plan

After admission, further tests were conducted. Analysis of the pericardial fluid showed the presence of acid-fast bacilli, indicating a diagnosis of tuberculous pericarditis. A targeted treatment plan was initiated using a combination of antitubercular medications and nonsteroidal anti-inflammatory drugs (NSAIDs). The patient was prescribed a triple-drug regimen: Isoniazid, Rifampicin, and Ethambutol Hydrochloride to combat the underlying tuberculosis infection. To manage inflammation and pain, Indomethacin was also administered. The patient responded positively to the treatment and agreed to continue the prescribed course.

Progress and Recovery

By the first day of treatment, the patient reported a noticeable improvement in his chest pain, shortness of breath, and dry cough. Vital signs were stable, and no new symptoms emerged. By the eighth day, he was symptom-free. His temperature was 36.5°C, heart rate was 73 beats per minute, and physical examination showed no abnormalities. Follow-up echocardiography confirmed no signs of pericardial effusion. The patient was discharged with a full recovery and advised to continue his medication regimen as prescribed.

Post-Discharge Recommendations

Before discharge, the patient was given detailed instructions on post-treatment care. It was emphasized that he must complete the full course of antitubercular therapy to avoid relapse or drug resistance. He was advised to maintain a nutritious diet rich in protein and vitamins, including foods such as chicken, fish, tomatoes, and cucumbers. Proper rest and dressing according to weather conditions were also encouraged. He was instructed to seek immediate medical attention if any symptoms returned.

Clinical Insights and Patient Awareness

This case highlights the importance of timely diagnosis and treatment, especially for conditions that mimic other illnesses. The patient initially ignored his symptoms and self-medicated, which led to a delay in treatment and worsening of his condition. Fortunately, with early hospitalization and appropriate therapy, he made a full recovery. It is crucial for individuals experiencing persistent or unusual symptoms—such as chest pain, unexplained fatigue, or shortness of breath—to seek professional medical evaluation without delay. Early intervention can significantly improve outcomes and prevent complications.