Pericarditis - after heart attack
Key points
- 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.
- Pericarditis may occur within 2 to 5 days after a heart attack (acute MI), or it may occur as much as 11 weeks later.
- 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.
- The goal is to improve the function of the heart and reduce symptoms.
Alternative names
Dressler's syndrome; Post-MI pericarditis; Post-cardiac injury syndrome; 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:
Written and revised by
David Cohen, M.D.
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