Sharp intermittent chest pain, sudden onset, relieved by leaning forward, with a harsh scratchy sound present in both systole and diastole. What is the most likely diagnosis?

Sharp intermittent chest pain, sudden onset, relieved by leaning forward, with a harsh scratchy sound present in both systole and diastole. What is the most likely diagnosis?

• A. Pneumonia
• B. Angina
• C. Pericarditis
• D. Myocardial infarction

Answer: (C)

Acute pericarditis is suggested by chest pain that is sharp and pleuritic, appears suddenly, and improves when you sit up and lean forward. The key finding is a pericardial friction rub—a harsh, scratchy sound heard with the stethoscope that can be present during both systole and diastole as the inflamed pericardial layers rub against each other. This combination—positional relief of pain and a friction rub—points to pericarditis. Pneumonia would typically cause fever, cough with sputum, and lung sounds abnormal over the affected area, not a pericardial scratch sound. Angina and myocardial infarction usually present with pressure or tightening chest pain that is exertional and not relieved by leaning forward, and they lack a pericardial friction rub.

Acute pericarditis is suggested by chest pain that is sharp and pleuritic, appears suddenly, and improves when you sit up and lean forward. The key finding is a pericardial friction rub—a harsh, scratchy sound heard with the stethoscope that can be present during both systole and diastole as the inflamed pericardial layers rub against each other. This combination—positional relief of pain and a friction rub—points to pericarditis.

Pneumonia would typically cause fever, cough with sputum, and lung sounds abnormal over the affected area, not a pericardial scratch sound. Angina and myocardial infarction usually present with pressure or tightening chest pain that is exertional and not relieved by leaning forward, and they lack a pericardial friction rub.