From the Guidelines
Pericarditis post myocardial infarction (MI) can lead to serious complications, including cardiac tamponade, which is a life-threatening condition that requires prompt medical attention. The complications of pericarditis post MI can be severe and may include pericardial effusion, concomitant pericardial inflammation, and subacute rupture 1.
Key Complications
- Cardiac tamponade: a life-threatening condition characterized by hypotension, elevated jugular venous pressure, and muffled heart sounds
- Pericardial effusion: a condition where fluid accumulates in the pericardial space, which can lead to cardiac tamponade
- Concomitant pericardial inflammation: inflammation of the pericardium that can lead to further complications
- Subacute rupture: a rare but serious complication that can occur in patients with post-MI pericarditis
Diagnosis and Treatment
The diagnosis of post-MI pericarditis is typically made using echocardiography and CMR to evaluate for the presence of a pericardial effusion and concomitant pericardial inflammation 1. The treatment of post-MI pericarditis is generally supportive, with aspirin and colchicine being considered for patients with persistent symptoms 1.
Management
The management of post-MI pericarditis should focus on reducing inflammation and preventing further complications, with aspirin and colchicine being considered as first-line therapy. Patients with post-MI pericarditis should be monitored closely for signs of cardiac tamponade and other complications, and should receive prompt medical attention if symptoms worsen or if complications arise 1.
Prevention
Timely primary percutaneous coronary intervention may reduce the occurrence of post-MI pericarditis, and patients with post-MI pericarditis should be monitored closely for signs of further complications 1.
From the Research
Complications of Pericarditis Post Myocardial Infarction
- Pericarditis can lead to various complications, including constrictive pericarditis, pericardial tamponade, and hemopericardium 2
- The development of constrictive pericarditis and pericardial tamponade can be life-threatening, although they occur in less than 0.5% and 3% of cases, respectively 3
- Cardiac tamponade is a rare but potentially fatal complication of pericarditis, which can occur in patients with large pericardial effusions 2
- Recurrence is the most frequent complication following acute pericarditis, occurring in up to 30% of patients, and can be reduced with the use of colchicine 4
Risk Factors for Complications
- Larger infarcts are associated with an increased risk of complications, including constrictive pericarditis and pericardial tamponade 2
- The use of glucocorticoids can increase the risk of recurrence, while colchicine can reduce this risk 4
- Multiple recurrences, lack of colchicine treatment, or use of glucocorticoids can increase the risk of further complications 4
Treatment and Management
- Treatment of pericarditis post myocardial infarction typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and colchicine to relieve symptoms and reduce the risk of recurrence 3, 4
- Corticosteroids may be used in patients who do not respond to NSAIDs and colchicine, but their use can increase the risk of recurrence 3, 4
- Immunoglobulins, immunosuppressive agents, and anti-interleukin-1 agents may be used in patients with recurrent pericarditis refractory to conventional treatment 4