Pericarditis - after heart attack

Answer 1

Definition

Pericarditis is inflammation and swelling of the covering of the heart (pericardium). The condition can occur in the days or weeks following a heart attack.

See also: Bacterial pericarditis

Alternative Names

Dressler syndrome; Post-MI pericarditis; Post-cardiac injury syndrome; Postcardiotomy pericarditis

Causes, incidence, and risk factors

Pericarditis may occur within 2 to 5 days after a heart attack, 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 that occurs shortly after a heart attack is caused by an overactive response by the body's immune system. When the body senses blood in the pericardial sac or dead or severely damaged heart tissue (as with a heart attack), it triggers an inflammatory response. Cells from the immune system try to clean up the heart after injury, but, in some cases, the cells can attack healthy tissue by mistake.

Pain occurs when the pericardium becomes inflamed (swollen) and rubs on the heart.

You have a higher risk of pericarditis if you have had a previous heart attack, open heart surgery, or chest trauma.

Symptoms

• Anxiety
• Chest pain
  • May come and go (recur)
  • Pain may be sharp and stabbing (pleuritic) or tight and crushing (ischemic)
  • Pain may get worse when breathing and may be go away when you stand or sit up
  • Pain moves to the neck, shoulder, back, or abdomen
• Difficulty breathing
• Dry cough
• Fast heart rate(tachycardia)
• Fatigue
• Fever
• General ill feeling (malaise)
• Splinting of ribs (bending over or holding the chest) with deep breathing

Signs and tests

The health care provider will use a stethoscope to listen to the heart and lungs. There may be a rubbing sound (not to be confused with a murmur), and heart sounds in general may be weak or sound far away.

Buildup of fluid in the covering of the heart or space around the lungs (pleural effusion) is not common after heart attack. But, it does occur in some patients with Dressler's syndrome.

Tests may include:

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

Treatment

The goal of treatment is to make the heart work better and reduce pain and other symptoms.

Nonsteroidal anti-inflammatory medications (NSAIDs) and aspirin may be used to treat inflammation of the pericardium. In extreme cases, when other medicines don't work, steroids or colchicine may be used.

In some cases, excess fluid surrounding the heart may need to be removed. This is done with a procedure calledpericardiocentesis. If complications develop, part of the pericardium may need to be removed with surgery (pericardiectomy).

Expectations (prognosis)

The condition may come back even in those who receive treatment. However, untreated pericarditis can be life threatening.

Complications

• Cardiac tamponade
• Constrictive heart failure
• Pulmonary edema

Calling your health care provider

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

Call your health care provider if pericarditis has been diagnosed and symptoms continue or come back, despite treatment.

ReferencesLeWinter MM. Pericardial Diseases. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa; Saunders Elsevier; 2007: chap 70.

Answer 2

Definition

Pericarditis is inflammation and swelling of the covering of the heart (pericardium). The condition can occur in the days or weeks following a heart attack.

See also: Bacterial pericarditis

Alternative Names

Dressler syndrome; Post-MI pericarditis; Post-cardiac injury syndrome; Postcardiotomy pericarditis

Causes, incidence, and risk factors

Two types of pericarditis can occur after a heart attack.

The first type of pericarditis most often occurs within 2 to 5 days after a heart attack. When the body tries to clean up the diseased heart tissue, swelling and inflammation occur.

The second type of pericarditis is also called Dressler's syndrome (or post-cardiac injury syndrome or postcardiotomy pericarditis). It occurs several weeks or months after a heart attack, heart surgery, or other trauma to the heart. Dressler's syndrome is believed to be caused by the immune system attacking the area.

Pain occurs when the pericardium becomes inflamed (swollen) and rubs on the heart.

You have a higher risk of pericarditis if you have had a previous heart attack, open heart surgery, or chest trauma, or if your heat attack affected the thickness of your heart muscle.

Symptoms

• Anxiety
• Chest pain
  • May come and go (recur)
  • Pain may be sharp and stabbing (pleuritic) or tight and crushing (ischemic)
  • Pain may get worse when breathing and may go away when you stand or sit up
  • Pain moves to the neck, shoulder, back, or abdomen
• Difficulty breathing
• Dry cough
• Fast heart rate(tachycardia)
• Fatigue
• Fever (more common with the second type of pericarditis)
• Malaise(general ill feeling)
• Splinting of ribs (bending over or holding the chest) with deep breathing

Signs and tests

The health care provider will use a stethoscope to listen to your heart and lungs. There may be a rubbing sound (called a pericardial friction rub, not to be confused with a heart murmur). Heart sounds in general may be weak or sound far away.

A buildup of fluid in the covering of the heart or space around the lungs (pericardial effusion) is not common after a heart attack. But, it often does occur in some patients with Dressler's syndrome.

Tests may include:

• Cardiac injury markers (CK-MB and troponin may help tell pericarditis from a heart attack)
• Chest CT scan
• Chest MRI
• Chest x-ray
• Complete blood count
• ECG
• Echocardiogram
• ESR(sedimentation rate) or C-reactive protein(measures of inflammation)

Treatment

The goal of treatment is to make the heart work better and reduce pain and other symptoms.

Nonsteroidal anti-inflammatory medications (NSAIDs) or aspirin may be used to treat inflammation of the pericardium. Usually aspirin, even in high doses, is preferred in early post-MI pericarditis. In extreme cases, when other medicines don't work, steroids or colchicine may be used.

In some cases, excess fluid surrounding the heart (pericardial effusion) may need to be removed. This is done with a procedure called pericardiocentesis. If complications develop, part of the pericardium may need to be removed with surgery (pericardiectomy).

Expectations (prognosis)

The condition may come back, even in people who receive treatment. In some cases, untreated pericarditis can be life threatening.

Complications

• Cardiac tamponade
• Congestive heart failure
• Constrictive pericarditis

Calling your health care provider

Call your health care provider if:

• You develop symptoms of pericarditis after a heart attack
• You have been diagnosed with pericarditis and symptoms continue or come back, despite treatment

References

Anderson JL. ST segment elevation acute myocardial infarction and complications of myocardial infarction. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 72.

Manning WJ. Pericardial disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 77.

LeWinter MM. Pericardial disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 70.

Reviewed By

Review Date: 07/10/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, Unviersity of Washington School of Medicine; and Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.