(aka Post-Pericardiotomy syndrome, Post-Pericardiectomy Syndrome, Post-MI Syndrome, Dressler’s Syndrome)

Epidemiology

• Time of Onset: usually develops about 3 weeks (range: 3 weeks-1 year) after inciting event
• Incidence: 1% after MI

---

Etiology

• Blunt Chest Trauma:
• Post-MI (see [[Coronary Artery Disease]])
• Post-Cardiac Surgery:
• Percutaneous LV Puncture:
• Post-Pacemaker Placement:

---

Physiology

• Injury to myocardium or pericardium -> immunologic mechanism (anti-heart antibodies can be detected, although it is unclear as to their role)

---

Diagnosis

• CBC: leukocytosis
• ESR: elevated
• Pleural Fluid:
  • Appearance: serosanguineous or bloody
  • Exudate
  • Glucose: >60 mg/dL
  • pH: >7.5
  • Cell Count and Diff: either PMN-predominant to mononuclear-predominent (depending on acuity of the process)

---

Clinical Features

Cardiac Manifestations

• Chest Pain
  • Usually precedes onset of fever
  • Varies from dull ache-agonizing crushing chest pain
  • May be pleuritic
• Pericardial Rub: may be present
• Pericardial Effusion
• Occlusion of CABG Grafts: may occur

Pulmonary Manifestations

• Pleuritis/Pleural Effusion (see [[Pleural Effusion-Exudate]])
  • Effusion occurs in 66% of cases
  • Effusions are usually bilateral and small
• Pneumonitis: pulmonary infiltrates present in 50% of cases

Constitutional Manifestations

• Fever

---

Treatment

• NSAID’s
  • ASA, indomethacin
  • Usually effective
• Corticosteroids
  • May be necessary for more severe cases
  • May be required to prevent occlusion of CABG grafts

---

References

• xx