Pericarditis - after heart attack

• 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.

• References
  LeWinter 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.

Review Date: 9/3/2008

Reviewed By: Larry A. Weinrauch, MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.