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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.

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Pericarditis post-IM
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Causes

Two types of pericarditis can occur after a heart attack.

Early pericarditis: This form most often 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:

Symptoms

Symptoms include:

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:

Treatment

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

Aspirin may be used to treat inflammation of the pericardium. A drug called colchicine is often used as well.

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 sometimes need to be removed with surgery (pericardiectomy).

Outlook (Prognosis)

The condition may recur in some cases.

Possible Complications

Possible complications of pericarditis are:

When to Contact a Medical Professional

Call your provider if:

Related Information

Heart attack
Open heart surgery
Immune response
Cardiac tamponade
Heart failure
Pulmonary edema

References

Jouriles NJ. Pericardial and myocardial disease. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 72.

LeWinter MM, Imazio M. Pericardial diseases. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 83.

Maisch B, Ristic AD. Pericardial diseases. In: Vincent J-L, Abraham E, Moore FA, Kochanek PM, Fink MP, eds. Textbook of Critical Care. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 84.

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Review Date: 7/30/2020  

Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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