Post-cardiac injury syndrome

Alternative names
Dressler’s syndrome; Post-MI pericarditis; Pericarditis - after heart attack; Postcardiotomy pericarditis

Definition
Pericarditis is an inflammation and swelling of the pericardium (the sac-like covering of the heart), which can occur in the days or weeks following a heart attack.

Causes, incidence, and risk factors

Pericarditis may occur within 2 to 5 days after a heart attack (acute MI), or it may occur as much as 11 weeks later. The condition is called Dressler’s syndrome when it persists for weeks or months after a heart attack. Pericarditis can also be caused by open heart surgery, stab wounds to the heart and blunt chest trauma. It may involve repeated episodes of symptoms.

Pericarditis occuring shortly after a heart attack is caused by the inflammatory response to blood in the pericardial sac or by the presence of dead or severely damaged tissue in the heart muscle. During the period of inflammation, the immune system tries to clean up the heart after injury, but it can sometimes go too far and attack healthy cells by mistake. Pain occurs when the inflamed pericardium rubs on the heart.

Early pericarditis complicates 7% to 10% of heart attacks. Dressler’s syndrome is seen in only 1% of patients after heart attack. Risks include previous heart attack, open heart surgery, or chest trauma.

Symptoms

     
  • chest pain       o may come and go (recurrence)       o pain radiates to the neck, shoulder, back, or abdomen       o described as sharp and stabbing (pleuritic)       o or described as tight and crushing (ischemic)  
  • chest pain may increase with breathing and may be relieved by an upright, standing or sitting position  
  • splinting of ribs (bending over or holding the chest) with deep breathing  
  • difficulty breathing  
  • dry cough  
  • anxiety  
  • fatigue  
  • fever  
  • general ill feeling (malaise)  
  • fast heart rate (tachycardia)

Signs and tests

Using a stethoscope, the doctor will listen for a pericardial rubbing sound (not be confused with a murmur), and heart sounds may be weak or distant. Collections of fluid in the pericardial sac or in the space around the lungs (pleural effusion) are not common after heart attack. They do occur with chronic post-MI pericarditis (Dressler’s syndrome).

Tests may include:

     
  • Chest X-ray  
  • Echocardiogram  
  • Chest MRI  
  • Chest CT scan  
  • ECG  
  • Cardiac markers (CK-MB and troponin may distinguish pericarditis from acute MI)  
  • Complete blood count shows increased white blood cells  
  • ESR (sedimentation rate) is high

Treatment

The goal is to improve the function of the heart and reduce symptoms.

Nonsteroidal anti-inflammatory medications (NSAIDS) and aspirin may be used to relieve inflammation of the pericardium. In extreme cases, when other medicines have failed, steroids or colchicine may be used. Other medications may include analgesics to relieve pain.

The removal of excess fluid from the pericardial sac (pericardiocentesis) may be recommended in some cases. Cutting or surgical removal of part of the pericardium (surgical pericardiectomy) is only implemented if complications develop.

Expectations (prognosis)
This disorder may cause severe symptoms or even be life-threatening if untreated. Recurrences are common even with adequate treatment.

Complications

Calling your health care provider

Call your health care provider if symptoms of pericarditis occur following a heart attack.

Call your health care provider if pericarditis has been diagnosed and symptoms persist or recur despite treatment.

Johns Hopkins patient information

Last revised: December 5, 2012
by Potos A. Aagen, M.D.

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