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Mehlman Cardiology Practice Exam

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A patient with STEMI two days ago now has a central friction rub. What is the most likely diagnosis?
Correct Answer:
Post-MI Fibrinous Pericarditis
Explanation:
Fibrinous pericarditis occurring after a myocardial infarction. After a STEMI, the inflammatory process can extend to the pericardium, causing sterile fibrinous exudate and a pericardial friction rub within the first day to a few days. This early post–MI pericarditis typically presents around 1–3 days after the infarct, which fits the scenario of symptoms appearing two days after the MI. Dressler syndrome is a later autoimmune pericarditis occurring weeks after the event, while uremic or autoimmune pericarditis is not tied to recent MI timing. So the timing and the finding point to post‑MI fibrinous pericarditis.

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