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Pericarditis - after heart attack

Contents of this page:

Illustrations

Acute MI
Acute MI
Post-MI pericarditis
Post-MI pericarditis
Pericardium
Pericardium

Alternative Names    Return to top

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

Definition    Return to top

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

Causes    Return to top

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    Return to top

Exams and Tests    Return to top

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:

Treatment    Return to top

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).

Outlook (Prognosis)    Return to top

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

Possible Complications    Return to top

When to Contact a Medical Professional    Return to top

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    Return to top

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.

Update Date: 9/3/2008

Updated 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.

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