A Case of Pericarditis: Should We Treat Medically or Surgically?

54-year-old male with a past history significant for hyperlipidemia, hypertension, and chronic reflux esophagitis presented with episodes of mid sternal chest pain associated with mild shortness of breath, aggravated by cough. The patient was active and well until about a month prior when he had flu-like illness with similar chest pain, which progressed to worsening fatigue, pedal edema, and NYHA class II-III symptoms.

Clinical examination revealed an elevated jugular venous pulse to the angle of jaw and 2+ bilateral pedal edema. Auscultation revealed normal dual heart sounds with no rub or murmurs and mild bilateral basal crackles.

Further laboratory investigation was negative for infectious serology and only significant for raised CRP of 244 mg/L.

The ECG, echocardiography and cardiac MRI images are shown (Figure 1 – Figure 4), which were acquired at the time of initial consultation.

Figure 1
Figure 2
Figure 3
Figure 4

What is the most likely clinical diagnosis and next best step in management?

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