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The physical examination found disseminated bronchial rales, no pleural friction rub, normal hemodynamic parameters (heart rate 84 beats per minute, blood pressure of 110/70 mmHg), varicose veins of left lower limb.
A pain of pericarditis, new onset murmur, pericardial friction rub and heart failure symptoms can be observed as initial ARF symptoms.
Acute pericarditis is diagnosed on the basis of pericardial pain, presence of a precordial friction rub, elevated ESR indicative of acute inflammation, and ECG findings of diffuse ST elevation and PR depression without pathologic Q waves.