Introduction: Acute pericarditis occurs when the fibroelastic sac between the parietal and visceral layer is inflamed. Uremic pericarditis occurs in patients with End stage renal disease and a BUN greater than 60mg/dl. We present a unique case of uremic pericarditis in a patient with typical chest pain and elevated troponin.

Case Presentation: 79-year-old female with a history of hypertension and chronic kidney disease presents with a substernal intermittent chest pain for the past three weeks. The pain radiates to her left upper extremity and neck and is associated with dyspnea, nausea, diaphoresis, and lightheadedness. Furthermore, the pain is alleviated with rest and sublingual nitroglycerin and is exacerbated with exertion. Physical examination significant for a 3/6 systolic ejection murmur best heard in the second intercostal space. EKG revealed sinus tachycardia with T wave inversions in leads II, III, V3-6. Initial troponin-I was .712 ng/ml, BUN and Cr were 86 mg/dl and 5.5 mg/dl, respectively. She was given one dose of aspirin 324mg, started on heparin drip, atorvastatin 40mg daily, and admitted for further evaluation. A transthoracic echocardiogram revealed an Ejection Fraction of 50-54%, grade 1 diastolic dysfunction, severe Aortic Stenosis, small pericardial effusion and no wall motion abnormalities.

Cardiology was consulted and cardiac catherization revealed normal coronary arteries. Given the normal coronary anatomy, emergent hemodialysis was initiated for uremic pericarditis. Nephrology was subsequently consulted and a renal ultrasound showed renal cortical thinning consistent with medical renal disease. Interventional radiology performed a renal biopsy revealing chronic IgA and IgG immune complex glomerulonephritis along with arterial nephrosclerosis.

Final Diagnosis: Uremic Pericarditis

Outcome: Patient symptoms resolved after several sessions of hemodialysis and she was discharged on outpatient hemodialysis.