Post-myocardial infarction pericarditis
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Post-myocardial infarction pericarditis occurs in approximately 5% to 6% of patients who receive thrombolytic agents. It should be suspected in any patient with pleuropericardial pain. A pericardial friction rub may or may not be present. Differentiation of pericarditis from recurrent angina may be difficult, but a careful history and evaluation of serial electrocardiograms can help distinguish the two entities. Dressler’s syndrome, pericarditis that occurs at least 1 week following myocardial infarction, is now exceedingly rare. Most cases of pericarditis have a benign course; however, because pericarditis is associ-ated with larger infarcts, overall long-term mortality rate is increased. Rare complications include hemopericardium, cardiac tamponade, and constrictive pericarditis. Therapy is directed toward relief of pain, which usually responds well to nonsteroidal anti-inflammatory agents (eg, aspirin or ibuprofen).
KeywordsIndomethacin Ibuprofen Pericardial Effusion Pericarditis Main Side Effect
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References and Recommended Reading
- 1.Correale E, Maggioni AP, Romano S, et al.: Comparison of frequency, diagnostic and prognostic significance of pericardial involvement in acute myocardial infarction treated with and without thrombolytics. Am J Cardiol 1993, 71:1377–1381. This important paper determines the incidence and prognos-tic significance of pericarditis in the GISSI-1 and GISSI-2 database. This paper is often quoted for its finding that thrombolytic therapy halves the frequency of pericarditis.PubMedCrossRefGoogle Scholar
- 2.Dressler W: The post-myocardial infarction syndrome. A report of forty-four cases. Arch Intern Med 1959, 103:28–41.Google Scholar
- 4.Tofler GH, Muller JE, Stone PH, et al.: Pericarditis in acute myocardial infarction: characterization and clinical significance. Am Heart J 1989, 117:86–90. This paper describes the findings of the Multicenter Investi-gation of the Limitation of Infarct Size (MILIS) study, which was designed to examine the effects of propranolol and hyaluronidase on infarct size. Patients who developed pericarditis were prospectively followed, and the outcomes are analyzed in this paper.PubMedCrossRefGoogle Scholar
- 5.Correale E, Maggioni AP, Romano S, et al.: Pericardial involvement in acute myocardial infarction in the post-thrombolytic era: clinical meaning and value. Clin Cardiol 1997, 20:327–331. This paper reviews the pathophysiology and difficulties in diagnosis of post-myocardial infarction pericarditis and discusses long-term outcome.PubMedGoogle Scholar
- 6.Oliva PB, Hammill SC, Edwards WD: Electrocardio-graphic diagnosis of postinfarction regional pericarditis. Ancillary observations regarding the effect of reperfusion on the rapidity and amplitude of T wave inversion after acute myocardial infarction. Circulation 1993, 88:896–904.PubMedGoogle Scholar
- 7.Oliva PB, Hammill SC: The clinical distinction between postinfarction pericarditis and other causes of postinfarction chest pain: ancillary observations regarding the effect of lytic therapy upon the frequency of postinfarction pericarditis, postinfarction angina, and reinfarction. Clin Cardiol 1994, 17:471–478.PubMedCrossRefGoogle Scholar
- 8.Roberts BM, Lessof MH: Immunological aspects of cardiovascular disorders. In Progress in Cardiology. Edited by Yu PN, Goodwin JF. Philadelphia: Lea & Febiger; 1973:31.Google Scholar
- 17.Tsang TSM, Freeman WK, Sinak LJ, Seward JB: Echocardiographically guided pericardiocentesis: evolution and state-of-the-art technique. Mayo Clin Proc 1998, 73:647–652. This paper describes in detail a step-by-step method of performing pericardiocentesis using two-dimensional echocardiographic guidance.PubMedGoogle Scholar