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Pericarditis - after heart attack

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

 

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

Causes

 

Two types of pericarditis can occur after a heart attack .

Early pericarditis: This form most occurs within 1 to 3 days after a heart attack. Inflammation and swelling develop as the body tries to clean up the diseased heart tissue.

Late pericarditis: This is also called Dressler syndrome. It is also called post-cardiac injury syndrome or postcardiotomy pericarditis). It most often develops several weeks or months after a heart attack, heart surgery, or other trauma to the heart. It can also happen a week after a heart injury. Dressler syndrome is thought to occur when the immune system attacks healthy heart tissue by mistake.

Things that put you at higher risk of pericarditis include:

  • A previous heart attack
  • Open heart surgery
  • Chest trauma
  • A heart attack that has affected the thickness of your heart muscle

 

Symptoms

 

Symptoms include:

  • Anxiety
  • Chest pain from the swollen pericardium rubbing on the heart. The pain may be sharp, tight or crushing and may move to the neck, shoulder, or abdomen. The pain may also be worse when you breathe and go away when you lean forward, stand, or sit up.
  • Trouble breathing
  • Dry cough
  • Fast heart rate (tachycardia)
  • Fatigue
  • Fever (common with the second type of pericarditis)
  • Malaise (general ill feeling)
  • Splinting of ribs (bending over or holding the chest) with deep breathing

 

Exams and Tests

 

The health care provider will listen to your heart and lungs with a stethoscope. 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 people with Dressler 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 (electrocardiogram)
  • 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 drugs (NSAIDs) or aspirin may be used to treat inflammation of the pericardium. A drug called colchicine is often used with these medicines.

Steroids are commonly used for Dressler syndrome. They are not often used for early pericarditis unless the condition does not respond to other treatment.

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).

 

Outlook (Prognosis)

 

The condition may come back, even in people who get treatment. Untreated pericarditis can be life threatening in some cases.

 

Possible Complications

 

Possible complications of pericarditis are:

  • Cardiac tamponade
  • Congestive heart failure
  • Constrictive pericarditis

 

When to Contact a Medical Professional

 

Call your 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

 

 

Open References

References

Imazio M, Brucato A, Forno D, et al. Efficacy and safety of colchicine for pericarditis prevention. Systematic review and meta-analysis. Heart . 2012;98(14):1078-1082. PMID: 22442198 www.ncbi.nlm.nih.gov/pubmed/22442198 .

LeWinter MM, Hopkins WE. Pericardial diseases. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 71.

Little WC, Oh JK. Pericardial diseases. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 77.

 
  • Acute MI

    Acute MI - illustration

    A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.

    Acute MI

    illustration

  • Pericardium

    Pericardium - illustration

    The pericardium is a thin double-layered sac which encloses the heart. Fluid is contained within the layers and lubricates the constantly rubbing surfaces.

    Pericardium

    illustration

  • Post-MI pericarditis

    Post-MI pericarditis - illustration

    Post-MI pericarditis is inflammation of the pericardium (the sac-like covering of the heart). Any previous injury to the heart muscle can cause pericarditis. Incidences of pericarditis are associated with Dressler's syndrome, after a heart attack, open heart surgery, and may also follow stab wounds to the heart or blunt chest trauma. Pain occurs when the inflamed pericardium rubs on the heart.

    Post-MI pericarditis

    illustration

  • Pericardium

    Pericardium - illustration

    The pericardial sac surrounds and protects the heart within the chest cavity.

    Pericardium

    illustration

    • Acute MI

      Acute MI - illustration

      A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.

      Acute MI

      illustration

    • Pericardium

      Pericardium - illustration

      The pericardium is a thin double-layered sac which encloses the heart. Fluid is contained within the layers and lubricates the constantly rubbing surfaces.

      Pericardium

      illustration

    • Post-MI pericarditis

      Post-MI pericarditis - illustration

      Post-MI pericarditis is inflammation of the pericardium (the sac-like covering of the heart). Any previous injury to the heart muscle can cause pericarditis. Incidences of pericarditis are associated with Dressler's syndrome, after a heart attack, open heart surgery, and may also follow stab wounds to the heart or blunt chest trauma. Pain occurs when the inflamed pericardium rubs on the heart.

      Post-MI pericarditis

      illustration

    • Pericardium

      Pericardium - illustration

      The pericardial sac surrounds and protects the heart within the chest cavity.

      Pericardium

      illustration

    A Closer Look

     

    Talking to your MD

     

      Self Care

       

        Tests for Pericarditis - after heart attack

         
         

        Review Date: 8/2/2016

        Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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