Post myocardial infarction pericarditis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Pericarditis}}
{{Pericarditis}}
{{CMG}}
{{CMG}}; {{AE}}


{{SK}} post MI pericarditis
{{SK}} post MI pericarditis
__NOTOC__
{{SI}}
{{CMG}}; {{AE}}
{{SK}}


==Overview==
==Overview==
Post-Myocardial Infarction Pericarditis, also named peri-infarction pericarditis, is defined as acute pericarditis occurring within 7 days following an acute myocardial infarction.


==Historical Perspective==
==Historical Perspective==
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
There have been several outbreaks of [disease name], including -----.
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
OR
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
OR
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
OR
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
OR
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
OR
The staging of [malignancy name] is based on the [staging system].
OR
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.
Extension of myocardial infarction to the epicardial surface, which occurs in transmural MI, causes local pericardial inflammation adjacent to the infarction zone with resultant acute fibrinous pericarditis.
 
OR
 
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
 
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
Acute fibrinous pericarditis occurs following transmural myocardial infarction.
 
OR
 
Common causes of [disease] include [cause1], [cause2], and [cause3].
 
OR
 
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
 
OR
 
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
 
==Differentiating ((Page name)) from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].


OR
==Differentiating peri-infarction pericarditis from other Diseases==
The chest pain of pericarditis must be differentiated from post-infarction angina and recurrent infarction.
Pleuritic nature of pain and/or radiation of pain to either trapezius ridge may help in differentiating PIP from other causes of chest pain following MI.


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
{| class="wikitable"
! scope="col" | Characteristic/Parameter
! scope="col" | '''Pericarditis'''
! scope="col" | '''Myocardial infarction'''
|-
! scope="row" | Pain description
| Sharp, [[pleuritic]], [[Sternal|retro-sternal]] (under the [[sternum]]) or left [[precordial]] (left [[chest]]) [[pain]].
| Crushing, pressure-like, heavy [[pain]]. Described as "elephant on the [[chest]]".
|-
! scope="row" | Radiation
|[[Pain]] [[Radiation|radiates]] to the [[Trapezius muscle|trapezius]] ridge (to the lowest portion of the [[scapula]] on the [[back]]) or no [[radiation]].
| Pain radiates to the [[jaw]], or the left or arm, or does not radiate.
|-
! scope="row" | Exertion
| Does not change the [[pain]]
| Can increase the [[pain]]
|-
! scope="row" | Position
|[[Pain]] is worse [[supine]] or upon [[inspiration]] ([[breathing]] in)
| Not positional
|-
! scope="row" | Onset/duration
| Sudden [[pain]], that lasts for hours or sometimes days before a [[patient]] comes to the [[ER]]
| Sudden or [[Chronic (medicine)|chronically]] worsening pain that can come and go in [[paroxysm]]s or it can last for hours before the [[patient]] decides to come to the [[ER]]
|}


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
The incidence of PIP has decreased in recent years due to following the widespread use of fibrinolytic or mechanical reperfusion therapy.  
 
Recent studies estimated an incidence of less than 2% among patients with ST-elevation MI.<ref name="pmid29370922">{{cite journal| author=Lador A, Hasdai D, Mager A, Porter A, Goldenberg I, Shlomo N | display-authors=etal| title=Incidence and Prognosis of Pericarditis After ST-Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey 2000 to 2013 Registry Database). | journal=Am J Cardiol | year= 2018 | volume= 121 | issue= 6 | pages= 690-694 | pmid=29370922 | doi=10.1016/j.amjcard.2017.12.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29370922  }} </ref>
OR
 
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
 
 
 
Patients of all age groups may develop [disease name].
 
OR
 
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
 
OR
 
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR
 
[Acute disease name] commonly affects [age group].
 
 
 
There is no racial predilection to [disease name].
 
OR
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].
OR
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
PIP is usually self-limited in most patients.
 
OR
 
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
 
OR
 
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* Historically, auscultation of pericardial friction rub has been considered as a diagnostic sign of PIP.
 
* The diagnosis of PIP is also made with the presence of pleuritic chest pain, particularly pain in one or both trapezius ridges.
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
The major clinical manifestations of PIP include:
* Chest pain; typically is centrally-located, sharp, and pleuritic. Pleuritic chest pain is defined as the pain that is worst during deep inspiration and improves by sitting up and leaning forward.
* Pericardial friction rub; although diagnostic for PIP, it may not be heard in all patients. A pericardial friction rub is usually described as a superficial scratchy or squeaking sound which is best heard with the diaphragm of the stethoscope over the left sternal border
* Pericardial effusion.  


OR
However, some patients may be asymptomatic and incidental hearing of friction rub may be the only finding in these patients.
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
The presence of friction rub on physical examination is diagnostic of PIP.
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


===Laboratory Findings===
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
* Cardiac biomarkers are often elevated in patients with due to recent MI.
 
* Inflammatory markers, such as CRP, might be elevated.
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
The typical ECG finding in PIP is new widespread ST elevation and/or PR depression which extends beyond a typical anatomic.  
 
However, in contrast to other etiologies of acute pericarditis, ECG findings might be less helpful in the diagnosis of PIP; since the ECG changes caused by recent MI might obscure or alter typical findings of acute pericarditis in the setting of PIP.
OR
However, the persistence of ST segments elevation and/or upright T waves, T waves that become upright again after having been inverted, may suggest PIP.<ref name="pmid8353916">{{cite journal| author=Oliva PB, Hammill SC, Edwards WD| title=Electrocardiographic 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. | journal=Circulation | year= 1993 | volume= 88 | issue= 3 | pages= 896-904 | pmid=8353916 | doi=10.1161/01.cir.88.3.896 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8353916  }} </ref><ref name="pmid7930200">{{cite journal| author=Oliva PB, Hammill SC, Talano JV| title=T wave changes consistent with epicardial involvement in acute myocardial infarction. Observations in patients with a postinfarction pericardial effusion without clinically recognized postinfarction pericarditis. | journal=J Am Coll Cardiol | year= 1994 | volume= 24 | issue= 4 | pages= 1073-7 | pmid=7930200 | doi=10.1016/0735-1097(94)90872-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7930200  }} </ref>
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
Chest radiography may reveal the presence of pericardial effusion to support the diagnosis.
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
Echocardiography is a useful imaging modality in assessing the presence of pericardial effusion in patients with PIP.  
 
It can also be helpful in differentiating other post-Mi complications as the etiology of pericardial effusion, such as free wall rupture.  
OR
However, the absence of pericardial effusion does not exclude PIP; and most effusions, if present, are small and not hemodynamically significant.
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
MRI may be useful in revealing pericardial effusion.  
 
Pericardial inflammation, particularly adjacent to the infarction zone, might be detected on late gadolinium enhancement.
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
There are no other diagnostic studies associated with [disease name].
OR
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
The majority of cases of PIP are self-limited.
Acetaminophen may be the initial treatment for patients with significant chest pain.
For those with more severe symptoms, and those who continue to have chest pain beyond initial 7-10 days, high-dose aspirin (650 mg every 6 to 8 hours) are preferred over other non- steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, which are in class III recommendation according to the 2013 guidelines of the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA).<ref name="pmid23247304">{{cite journal| author=O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA | display-authors=etal| title=2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2013 | volume= 127 | issue= 4 | pages= e362-425 | pmid=23247304 | doi=10.1161/CIR.0b013e3182742cf6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23247304  }} </ref>


OR
NSAIDS and glucocorticoids may interfere with proper myocardial healing and scar formation.


Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
Routine administration of colchicine (along with aspirin) in these patients is still controversial.  


OR
Although it has been suggested that antiplatelet and anticoagulant therapy may increase the risk of hemorrhagic pericardial effusion in patients with PIP, currently there is no enough evidence to prohibit administration of aspirin and other anticoagulants in these patients.
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
OR
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
OR
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].


==References==
==References==
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Latest revision as of 00:05, 16 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords: post MI pericarditis

Overview

Post-Myocardial Infarction Pericarditis, also named peri-infarction pericarditis, is defined as acute pericarditis occurring within 7 days following an acute myocardial infarction.

Historical Perspective

Classification

Pathophysiology

Extension of myocardial infarction to the epicardial surface, which occurs in transmural MI, causes local pericardial inflammation adjacent to the infarction zone with resultant acute fibrinous pericarditis.

Causes

Acute fibrinous pericarditis occurs following transmural myocardial infarction.

Differentiating peri-infarction pericarditis from other Diseases

The chest pain of pericarditis must be differentiated from post-infarction angina and recurrent infarction. Pleuritic nature of pain and/or radiation of pain to either trapezius ridge may help in differentiating PIP from other causes of chest pain following MI.

Characteristic/Parameter Pericarditis Myocardial infarction
Pain description Sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain. Crushing, pressure-like, heavy pain. Described as "elephant on the chest".
Radiation Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation. Pain radiates to the jaw, or the left or arm, or does not radiate.
Exertion Does not change the pain Can increase the pain
Position Pain is worse supine or upon inspiration (breathing in) Not positional
Onset/duration Sudden pain, that lasts for hours or sometimes days before a patient comes to the ER Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the patient decides to come to the ER

Epidemiology and Demographics

The incidence of PIP has decreased in recent years due to following the widespread use of fibrinolytic or mechanical reperfusion therapy. Recent studies estimated an incidence of less than 2% among patients with ST-elevation MI.[1]

Risk Factors

Screening

Natural History, Complications, and Prognosis

PIP is usually self-limited in most patients.

Diagnosis

Diagnostic Study of Choice

  • Historically, auscultation of pericardial friction rub has been considered as a diagnostic sign of PIP.
  • The diagnosis of PIP is also made with the presence of pleuritic chest pain, particularly pain in one or both trapezius ridges.

History and Symptoms

The major clinical manifestations of PIP include:

  • Chest pain; typically is centrally-located, sharp, and pleuritic. Pleuritic chest pain is defined as the pain that is worst during deep inspiration and improves by sitting up and leaning forward.
  • Pericardial friction rub; although diagnostic for PIP, it may not be heard in all patients. A pericardial friction rub is usually described as a superficial scratchy or squeaking sound which is best heard with the diaphragm of the stethoscope over the left sternal border
  • Pericardial effusion.

However, some patients may be asymptomatic and incidental hearing of friction rub may be the only finding in these patients.

Physical Examination

The presence of friction rub on physical examination is diagnostic of PIP.

Laboratory Findings

  • Cardiac biomarkers are often elevated in patients with due to recent MI.
  • Inflammatory markers, such as CRP, might be elevated.

Electrocardiogram

The typical ECG finding in PIP is new widespread ST elevation and/or PR depression which extends beyond a typical anatomic. However, in contrast to other etiologies of acute pericarditis, ECG findings might be less helpful in the diagnosis of PIP; since the ECG changes caused by recent MI might obscure or alter typical findings of acute pericarditis in the setting of PIP. However, the persistence of ST segments elevation and/or upright T waves, T waves that become upright again after having been inverted, may suggest PIP.[2][3]

X-ray

Chest radiography may reveal the presence of pericardial effusion to support the diagnosis.

Echocardiography or Ultrasound

Echocardiography is a useful imaging modality in assessing the presence of pericardial effusion in patients with PIP. It can also be helpful in differentiating other post-Mi complications as the etiology of pericardial effusion, such as free wall rupture. However, the absence of pericardial effusion does not exclude PIP; and most effusions, if present, are small and not hemodynamically significant.

CT scan

MRI

MRI may be useful in revealing pericardial effusion. Pericardial inflammation, particularly adjacent to the infarction zone, might be detected on late gadolinium enhancement.

Other Imaging Findings

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

Treatment

Medical Therapy

The majority of cases of PIP are self-limited. Acetaminophen may be the initial treatment for patients with significant chest pain. For those with more severe symptoms, and those who continue to have chest pain beyond initial 7-10 days, high-dose aspirin (650 mg every 6 to 8 hours) are preferred over other non- steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, which are in class III recommendation according to the 2013 guidelines of the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA).[4]

NSAIDS and glucocorticoids may interfere with proper myocardial healing and scar formation.

Routine administration of colchicine (along with aspirin) in these patients is still controversial.

Although it has been suggested that antiplatelet and anticoagulant therapy may increase the risk of hemorrhagic pericardial effusion in patients with PIP, currently there is no enough evidence to prohibit administration of aspirin and other anticoagulants in these patients.

Surgery

Primary Prevention

Secondary Prevention

References

  1. ↑ Lador A, Hasdai D, Mager A, Porter A, Goldenberg I, Shlomo N; et al. (2018). "Incidence and Prognosis of Pericarditis After ST-Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey 2000 to 2013 Registry Database)". Am J Cardiol. 121 (6): 690–694. doi:10.1016/j.amjcard.2017.12.006. PMID 29370922.
  2. ↑ Oliva PB, Hammill SC, Edwards WD (1993). "Electrocardiographic 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. 88 (3): 896–904. doi:10.1161/01.cir.88.3.896. PMID 8353916.
  3. ↑ Oliva PB, Hammill SC, Talano JV (1994). "T wave changes consistent with epicardial involvement in acute myocardial infarction. Observations in patients with a postinfarction pericardial effusion without clinically recognized postinfarction pericarditis". J Am Coll Cardiol. 24 (4): 1073–7. doi:10.1016/0735-1097(94)90872-9. PMID 7930200.
  4. ↑ O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA; et al. (2013). "2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. 127 (4): e362–425. doi:10.1161/CIR.0b013e3182742cf6. PMID 23247304.


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