Pericardial Disease

A single patient, two failed trials into a drug everyone agrees should work. The disagreement isn't about whether colchicine prevents recurrence — it's about whether tolerability failure and treatment failure are the same thing, and what a third attempt should cost him if they're not.

The trial that established colchicine's post-MI benefit and the newer, larger trial that didn't reproduce it were run on nearly identical populations. The disagreement between them is current, real, and unresolved by anything in her chart.

Four days into standard NSAID and colchicine therapy, his pain hasn't resolved — and his declining kidney function is closing off the easy way to push the anti-inflammatory regimen harder.

Colchicine has now failed to prevent recurrence twice, and the steroid courses used to control each flare are showing up in her glucose and bone density — not just her chest pain history.

His echocardiogram fits constrictive pericarditis, but two exam clues point toward amyloidosis instead — a distinction that changes not just the diagnosis but how much a delay actually costs him.

A confirmed case of constriction, caught while the patient still works full shifts and shows only mild symptoms. The disagreement is between operating while outcomes are best and giving still-active inflammation a real chance to resolve on its own.

New pericardial inflammation twelve days after a large anterior infarction needs treating, but the usual first-line drug for pericarditis carries a specific, separate concern in a patient this soon after his heart attack.