NSTEMI or Pericarditis: Which Came First?

Myocardial infarction (MI) is a common cardiac event often occurring in patients with a history of cardiovascular disease. MI is classified by the presence of ST segment elevation (STEMI) or non-ST segment elevation (NSTEMI). Pericarditis is inflammation of the pericardium usually caused by a bacterial or viral infection. The patient under discussion is an 86-year-old male with a previous history of coronary artery disease (CAD), hypertension (HTN), hyperlipidemia, and percutaneous coronary intervention (PCI). He presented with a three-week history of exertional chest pain that abated with rest and worsened while supine. EKG and laboratory findings supported a diagnosis of NSTEMI, and he was subsequently treated with PCI. This patient’s positional chest pain raises suspicion for acute pericarditis, which does not usually predispose to NSTEMI and, rather, is known to occur after MI. In this case of coexisting NSTEMI and acute pericarditis symptoms, we discuss the possibility of one condition predisposing to the other and assess the coincidental nature of the two conditions existing simultaneously.