A patient with severe pleuritic chest pain relieved by sitting up and leaning forward most likely has which condition?

• A. Pneumothorax
• B. Myocardial infarction
• C. Pericarditis
• D. Pulmonary embolism

Answer: (C)

Pain that is sharp and worsens with deep breaths but improves when you sit up and lean forward is classic for pericarditis. The inflamed pericardial sac allows friction during respiration, so leaning forward relieves some of that friction and eases the pain. Pericarditis often presents with this positional relief and may be accompanied by a pericardial friction rub and diffuse ST elevations on ECG.

Other causes of chest pain with a pleuritic quality don’t fit the posture-pain pattern as neatly. Pneumothorax tends to present with sudden unilateral chest pain and shortness of breath and is not characteristically relieved by sitting up. Myocardial infarction pain is typically pressure-like rather than pleuritic and isn’t helped by changing position. Pulmonary embolism can cause pleuritic pain too, but relief with leaning forward is not a typical feature.