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Pericarditis; post-MI Causes and Risks:
Post-MI pericarditis may occur within 2 to 5 days after an acute MI ( heart attack ), or it may occur as much as 11 weeks later. Dressler's syndrome is a post-MI pericarditis that develops weeks to several months after MI or open heart surgery . Dressler's syndrome may have repeated episodes of symptoms.
It may also follow open heart surgery, stab wounds to the heart, or blunt chest trauma.
Post-MI pericarditis is caused by inflammatory response to blood in the pericardial sac or necrotic (dead or severely damaged) tissue in the heart muscle . Pain occurs when the inflamed pericardium rubs on the heart.
Post-MI pericarditis occurs in approximately 4 out of 100,000 people. Risks include previous heart attack, open heart surgery, or chest trauma.
Prevention:
This may be an unavoidable complication of heart attack , open heart surgery , or trauma.
Symptoms:
- chest pain , pleuritic or ischemic type
- may come and go (recurrence)
- pain radiates to the neck, shoulder, back or abdomen
- described as sharp and stabbing (pleuritic)
- or described as tight and crushing (ischemic)
- chest pain may increase with breathing
- splinting of ribs (bending over or holding the chest) with deep breathing
- upright, standing, or sitting position may relieve pain
- difficulty breathing
- dry cough
- anxiety
- fatigue
- fever
- malaise ( general ill feeling )
Signs and Tests:
Listening to the chest with a stethoscope ( auscultation ) commonly reveals a pericardial rubbing sound, and heart sounds may be weak or distant. Collections of fluid in the space around the lungs ( pleural effusion ) or in the pericardial sac (pericardial effusions) are not common after acute MI . They do occur with chronic post-MI pericarditis (Dressler's syndrome).
Tests may include:
Treatment:
The goals of treatment are to improve heart function and reduce symptoms.
Aspirin (see salicylates - oral), nonsteroidal anti-inflammatory medications (NSAIDS), or corticosteroids (see corticosteroids - oral) may be used to relieve inflammation of the pericardium. Other medications may include analgesics to relieve pain and diuretics to remove excess fluid.
Little activity is recommended; bedrest with the head elevated helps reduce the workload of the heart.
The removal of excess fluid from the pericardial sac ( pericardiocentesis ) may be recommended in some cases. Cutting or resection of part of the pericardium (surgical pericardiectomy) is rare in the treatment of post-MI pericarditis.
Prognosis:
This disorder may be life-threatening if untreated. Recurrences are common even with adequate treatment.
Complications:
Call Your Healthcare Provider:
Call your health care provider if symptoms of post-MI pericarditis occur.
Call your health care provider if post-MI pericarditis has been diagnosed and symptoms persist or recur despite treatment.
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