Question

A 60-year-old man, following up after a recent myocardial infarction, presents with sharp inspiratory chest pain. Other than his recent myocardial infarction, his past medical history is significant for peptic ulcer and renal insufficiency. You suspect Dressler's syndrome after seeing diffuse ST elevations on an electrocardiogram. What is the most appropriate treatment for this patient?

1. Indomethacin
2 Ibuprofen
3 A corticosteroid taper
4 Hydrocodone
5 Diclofenac sodium

Answer 1

For a patient with suspected Dressler's syndrome who has a history of peptic ulcer and renal insufficiency, a corticosteroid taper is the most appropriate treatment to provide anti-inflammatory effects and avoid exacerbating the patient's other conditions.

Step-by-step explanation:

The most appropriate treatment for a patient suspected of having Dressler's syndrome, which is a type of post-myocardial infarction syndrome, is the use of anti-inflammatory medications. Given the patient's history of peptic ulcer and renal insufficiency, corticosteroids may be the safest option as some nonsteroidal anti-inflammatory drugs (NSAIDs) can exacerbate both peptic ulcers and renal problems. Therefore, a corticosteroid taper is the most appropriate choice among the listed options. It's important to avoid NSAIDs like indomethacin, ibuprofen, and diclofenac sodium in patients with peptic ulcer and renal insufficiency. Moreover, hydrocodone, an opioid, would primarily address pain but not the inflammation associated with Dressler's syndrome and it does not have anti-inflammatory properties.