In the case of acute chest pain relieved by leaning forward and confirmed by ST elevations on EKG, what is the most appropriate initial treatment?

In cases of acute chest pain that is relieved by leaning forward and is associated with ST elevations on an EKG, the clinical picture suggests pericarditis. This condition often presents with sharp chest pain that worsens when lying down and improves when sitting or leaning forward. The ST elevations seen on the EKG are usually diffuse rather than localized as in myocardial infarction.

The most appropriate initial treatment for pericarditis is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs help to reduce inflammation and manage pain associated with the condition effectively. They act on the inflammatory process, which is a key component of pericarditis.

While corticosteroids can also be used in severe cases or when NSAIDs are contraindicated, they are not the first-line treatment due to potential side effects and the risk of delaying resolution of the inflammation. Antibiotics are not indicated unless there is a clear infectious etiology, which is not typical in uncomplicated pericarditis. Similarly, ACE inhibitors are used in the management of heart failure and hypertension but do not address the pain or underlying inflammation present in pericarditis. Thus, NSAIDs stand out as the most appropriate and effective initial treatment for this scenario.