To the Editor.
—The report of pain during pericarditis in a uremic patient, ascribed to atherosclerosis "as a possible cause,"1 raises several points. The authors wisely indicated that coronary atherosclerosis was only a possibility, since, from the data given, one could hardly be conclusive. The patient had a rub and had ECG changes that were compatible with pericarditis. It should be noted that in uremic pericarditis, subepicardial myocarditis is rare, so that typical ST-segment deviations are unusual. However, uremic patients are susceptible to pericarditis of nonuremic (eg, viral or pneumococcal) cause. As the authors note, continuous chest pain is, indeed, consistent with the diagnosis of pericarditis. Yet, relief by assumption of the upright position is equally characteristic of myocardial ischemic and pericardial pain. Perhaps the authors could supply missing laboratory data, which certainly would have been obtained had any suspicion of ischemic pain arisen during the treatment of this
Spodick DH. Pericarditis Pain in Uremic Patients. Arch Intern Med. 1981;141(2):270. doi:10.1001/archinte.1981.00340020132040