Pericarditis - after heart attack

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

  • Alternative Names
    • Dressler syndrome; Post-MI pericarditis; Post-cardiac injury syndrome; Postcardiotomy pericarditis

  • 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 (or 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 (more 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 patients with Dressler's syndrome.

      Tests may include:

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

      Nonsteroidal anti-inflammatory medications (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's 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
  • When to Contact a Medical Professional
    • Call your health care 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
  • References
    • Imazio M, Brucato A, Forno D, Ferro S, Belli R, Trinchero R, Adler Y. Efficacy and safety of colchicine for pericarditis prevention. Systematic review and meta-analysis. Heart. 2012 Jul;98(14):1078-82. Epub 2012 Mar 22. PMID: 22442198

      LeWinter MM, Hopkins WE. Pericardial diseases. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 71.