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Matthew DeLaney, MD and Mike Weinstock, MD
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Pericarditis is a non-life threatening cause of chest pain that can be diagnosed using a combination of historical elements, exam findings, and an EKG. While the majority of patients with pericarditis have a benign clinical course, providers should consider the likelihood of other non-benign causes of chest pain before making this diagnosis.

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Tracy F. -

I was wondering if you have any information regarding the ceiling dose on naproxen. Thanks!

Mike W., MD -

Thanks for your question. Though the ceiling analgesic dose of naproxen has not been studied as it has for ketorolac and ibuprofen, 500 mg twice daily is a reasonable estimate.
Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP
Assistant Professor of EM, Harvard Medical School
Attending Pharmacist, EM & Toxicology, MGH
Twitter: @PharmERToxGuy

sandra r. -

I have noted providers recommending OTC Aleve (Naproxen Sodium) at a dose of 2 tabs BID x5 d for acute musculoskeletal pain. Is this a safe and acceptable practice in an otherwise healthy young person. I assume from you response above the topic has not been adequately studied however it does seem to be a widely used clinical practice.

Mike W., MD -

So this would b a dose of 400mg BID which is so similar to the prescribed 375mg BID so it does seem to be a safe and likely less expensive alternative - thx for the comment!

Susan M. -

Very helpful link to review EKG changes - thanks.

Angelina M., PA-C -

I was wondering, for the uncomplicated pericarditis case, how soon should an outpatient echo be done? And if the patient cannot get one done in the recommended timeframe would this then be an indication for transfer to the ED for an echo or do you think it is okay to not have an echo done at all as long as symptoms are improving and the patient has scheduled follow up with PCP? Also, how soon should they be following up with their PCP? Thanks!

Mike W., MD -

It certainly does seem reasonable that an echo within the next few days should be fine as long as there are no signs of tamponade. Pt should be started on nsaids. If an emergent echo needs done, then transfer to the ED is appropriate and a great idea. Thx for the question!! M

Angelina M., PA-C -

My question was stemming from a recent encounter with a 21 y/o otherwise healthy male patient with classic pericarditis hx and ekg. He had no signs of tamponade and felt completely fine other than the chest pain. The soonest they could get him an out-pt echo was in 1 wk, I wasn't sure if this was soon enough and if it is going to be more than a few days should you send the patient to ED just for this to be done. I saw him on a Friday and by the time he followed up on Monday his symptoms had already completely resolved and his crp returned to normal with treatment; given this, I wasn't sure that he was still going to need an echo despite the 2013 ASE guidelines recommending all patients with pericarditis have an echo. Additionally, I was curious if anyone knows why we taper the NSAID after 1-2 wks? I get that the prolonged duration also helps prevent recurrence but It seems like once you drop below the higher/anti-inflammatory doses if IBU there wouldn't be much benefit for an inflammatory condition? Thanks so much!

Mike W., MD -

Hard to make too many comments on description of a case, but if he is now asymptomatic... I agree w you that this certainly argues against tamponade! Don't know about the veracity of literature on tapering of NSAIDS...

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Pericarditis: Getting To The Heart Of The Matter Full episode audio for MD edition 177:10 min - 83 MB - M4AHippo Urgent Care RAP - February 2018 Written Summary 283 KB - PDF