Which symptom is typical of pericarditis?

• A. Sharp tearing chest pain
• B. Pleuritic chest pain worse lying down and better leaning forward
• C. Chest pain improved with rest
• D. Chest pain only with exertion

Answer: (B)

Pericarditis classically presents with sharp, pleuritic chest pain that is highly posture-dependent. The pain tends to worsen with deep inspiration and when lying flat, and it improves when the patient sits up and leans forward. Leaning forward reduces the irritation and friction of the inflamed pericardium, easing the pain. This pattern—pleuritic chest pain that is worse lying down and better leaning forward—is the hallmark feature of pericarditis.

Other patterns point to different problems: a sharp tearing pain suggests aortic dissection, pain that improves with rest aligns more with ischemic or musculoskeletal causes, and pain only with exertion is typical of angina. Pericarditis may also be accompanied by a pericardial friction rub, fever, and certain ECG changes (diffuse ST elevations with PR depressions), which can help confirm the diagnosis.