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Pericarditis

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
PharmERToxGuy.com

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!
M

Susan M. -

Very helpful link to review EKG changes - thanks.

Angelina M. -

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

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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

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