An Audible Case of Acute Pericarditis

A 33-year-old soldier presented with a 5-day history of unremitting substernal chest pain that radiated to his shoulders. The pain was worse when he was lying down and improved when he leaned forward. A 33-year-old soldier presented with a 5-day history of unremitting substernal chest pain that radiated to his shoulders. The pain was worse when he was lying down and improved when he leaned forward. He reported having no dyspnea. He had no chest-wall tenderness and had not undergone any recent trauma. Laboratory analysis revealed an elevation in the white-cell count, erythrocyte sedimentation rate, and fibrin D-dimer level. In the emergency department, his cardiac-enzyme levels were found to be normal, as were results on computed tomography for pulmonary embolism. The next day, a three-component friction rub was heard during auscultation (Panel A . . .