sle again - cd45

[ArchivalUser]

A 20-year-old man with SLE presents to the emergency department with chest pain that started 10 days ago. He has become increasingly dyspneic over the last 48 hours and has been too exhausted to make meals. He will not lay flat on the examination table and insists on leaning slightly forward. Blood pressure is 94/50 mm Hg and heart rate is 100 bpm. The heart sounds are quiet, and tubular breath sounds are heard at the left scapular border. There is 1+ peripheral edema. Chest radiograph shows a possible cardiomegaly. What is the next step in this patient™s management?

a Arterial blood gas
b Diuresis with intravenous furosemide
c Echocardiogram
d High-dose nonsteroidal medication
e Infusion of stress dose steroids

[ArchivalUser]

C. Libman Sack

[ArchivalUser]

sle causing lse...well maybe relief dyspnea 1st with iv furosemide??

[ArchivalUser]

no, heart suound normal, no murmur, so , looks pericarditis,
go for D.

[ArchivalUser]

Echocardiogram. Serositis in SLE can involve the pericardial, pleural, or gastrointestinal serosal surfaces. Pericarditis is the most frequent cardiac manifestation of SLE, and presentation can range from small to large effusions that can increase gradually or rapidly. Although tamponade is rare, it must be considered in any patient who presents with symptoms of cardiac compromise. Generally, the most accessible means of evaluation is echocardiogram. Treatment will include steroids, but in this degree of illness, the preferred dose is 1000 mg methylprednisolone daily for 3 days. Nonsteroidal anti-inflammatory drugs are an adjunctive therapy in serosal inflammation but are not sufficient for primary treatment. Diuresis would be dangerous, as cardiac output is dependent on the right ventricular filling pressure. Pulse oximetry would be sufficient to estimate oxygen saturation; an arterial blood gas is not necessary at this point.