Post cardiac injury syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: PMIS

Overview

Post cardiac injury syndrome (PCIS) encompasses two causes of pericarditis: #Post myocardial infarction syndrome (PMIS) or Dressler's syndrome and

1. Postpericardiotomy syndrome (PCS)

Pathophysiology

Both syndromes represent the delayed occurrence of pericarditis. Post-myocardial infarction syndrome is obviously due to myocardial infarction and postpericardiotomy syndrome is due to the myocardial injury that occurs during cardiac surgery.

Natural History, Complications and Prognosis

most often the course of PCIS is benign. Rare complications include development of cardiac tamponade, pericardial constriction, and saphenous vein graft occlusion.

Diagnosis

Symptoms

Both syndromes share common symptoms which include fever and pleuritic pain.

Physical Examination

The following findings may be present:

Cardiovascular

A pericardial friction rub

Lungs

A pleural effusion

Laboratory Studies

The following lab abnormalities may be present:

• An elevated erythrocyte sedimentation rate.
• A leukocytosis.

= = Chest x-ray = =

A pleural effusion with or without pulmonary infiltrates may be present.

Evidence supports an immunopathic etiology; viruses may play a contributing role. Anti-inflammatory agents are helpful; indo-methacin and steroids are preferably avoided. Rarely, PMIS-like syndrome may occur following pulmonary embolism. Anticoagulation and steroids have been used successfully in the latter situation.