Presentation
The data presented document that pleuropulmonary involvement is a common manifestation of postcardiac injury syndrome. [ncbi.nlm.nih.gov]
Moreover, it has never been reported that PCIS presenting as mediastinitis occurs after an AMI. Our case is the first case of PCIS presenting as acute mediastinitis. [synapse.koreamed.org]
Respiratoric
- Pleuritic Pain
The disease consists of a persistent low-grade fever, chest pain (usually pleuritic in nature), pericarditis (usually evidenced by a pericardial friction rub ), and/or a pericardial effusion. [en.wikipedia.org]
Symptoms include: chest pain that’s worse when lying down chest pain that worsens with deep breathing or coughing (pleuritic pain) fever difficult or labored breathing fatigue decreased appetite Dressler syndrome is difficult to diagnose because its symptoms [healthline.com]
Introduction Post pericardiotomy syndrome (PPS) was first described in 1953 in patients who developed fever and pleuritic pain after undergoing mitral valve surgery 1. [acc.org]
pain, friction rubs, pleural effusions, pneumonitis, and abnormal ECG and radiography findings (see Workup). [emedicine.medscape.com]
Cardiovascular
- Chest Pain
Four hours after the procedure, the patient developed pleuritic chest pain, with a low-grade fever. [amjmed.org]
One should consider this diagnosis after coronary angioplasty when the patient develops sudden chest pain and if the chest CT reveals pericardial thickening with small gas bubbles. [synapse.koreamed.org]
The case adds a differential diagnosis to chest pain and malaise following PTCA. [ncbi.nlm.nih.gov]
- Heart Disease
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pericardial Disease, Genetic Arrhythmic Conditions, Cardiac Surgery and Arrhythmias [acc.org]
Postpericardiotomy syndrome following surgery for nonrheumatic heart disease. Circulation. 1958;17(4, Part 1):549–56. PubMed CrossRef Google Scholar 6. Kaye D, Frankl W, Arditi LI. [link.springer.com]
Other NSAIDs though once used to treat Dressler syndrome, are less advocated and should be avoided in patients with ischemic heart disease. [en.wikipedia.org]
Pericardial diseases. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 83. Little WC, Oh JK. [medlineplus.gov]
- Retrosternal Chest Pain
chest pain, often radiating to the neck, shoulders, or back. [clevelandclinicmeded.com]
Workup
Multimodality cardiovascular imaging and diagnostic work-up 4.1 Multimodality imaging 4.1.1 Chest X-ray 4.1.2 Echocardiography 4.1.6 Cardiac catheterization 4.1.7 Multimodality imaging 4.2 Proposal for a general diagnostic workup 5. [escardio.org]
He had extensive testing, including workup for ischemic heart disease. A left heart catheterization was done, revealing non-obstructive coronary artery disease. [cureus.com]
[…] or late postoperative cardiac tamponade [15] and even recurrent cardiac tamponade. [16] The syndrome is also characterized by pericardial or pleuritic pain, friction rubs, pleural effusions, pneumonitis, and abnormal ECG and radiography findings (see Workup [emedicine.medscape.com]
X-Ray
- Pericardial Effusion
Among them, 6 patients (6/21, 28.6%) were diagnosed with PCIS secondary to cardiac perforation because they also developed pleural effusions (6/6, 100%) and fever (4/6, 66.7%) in addition to pericardial effusion/tamponade. [ncbi.nlm.nih.gov]
Among them, 6 patients (6/21, 28.6%) were diagnosed with PCIS secondary to cardiac perforation because they also developed pleural effusion (6 pts, 100%) and fever (4 pts, 66.7%) in addition to pericardial effusion/tamponade. [circ.ahajournals.org]
Pericardial effusion is common, and there may be pleural effusion with or without pulmonary infiltrates. There is often a latent period of days to weeks between injury and symptom onset. [amjmed.org]
QT, RR, ST Intervals
- ST Elevation
ECG demonstrating global ‘saddle shaped’ ST elevation consistent with pericarditis (C). Chest radiography showing bilateral pleural effusion (D). [amjmed.org]
Postcardiac injury syndrome Acute Pericarditis After Percutaneous Coronary Intervention Mimicking Inferolateral ST-Elevation Myocardial Infarction January 29, 2013 The authors describe a rare case of postcardiac injury syndrome manifesting as acute pericarditis [invasivecardiology.com]
[…] outcome associated with emergency coronary angiography in patients with ST elevation after cardiac arrest. 19 - 21, 24, 26 - 29, 31 Fewer data are available to evaluate coronary angiography in patients without ST elevation on the initial ECG. [eccguidelines.heart.org]
Originating from S wave Concave upwards Lead V 6 : ST-T amplitude >0.24 mm Focal—vascular territory Originating from R wave Convex upwards ST depression Lead aV R only Present; reciprocal changes to ST elevation according to territory PR segment Leads [clevelandclinicmeded.com]
"Primary percutaneous coronary intervention and mild induced hypothermia in comatose survivors of ventricular fibrillation with ST-elevation acute myocardial infarction." Resuscitation 74.2 (2007): 227-234. Menegazzi, James J. [derangedphysiology.com]
Treatment
Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual. [books.google.com]
In spite of receiving anti-inflammatory treatment, the patient developed relapsing PCIS. [ncbi.nlm.nih.gov]
Prognosis
Although PCIS can follow a relapsing course, it does carry a favorable prognosis. [ncbi.nlm.nih.gov]
Pericardial syndromes 3.1 Acute pericarditis 3.1.1 Clinical management and therapy 3.1.2 Prognosis 3.2 Incessant and chronic pericarditis 3.3 Recurrent pericarditis 3.3.1 Therapy 3.3.2 Prognosis 3.4 Pericarditis associated with myocardial involvement [escardio.org]
The prognosis of the PCIS is relatively good for most patients; however, 10 to 15% of cases will experience a recurrence 5. [immunologyresearchjournal.com]
Advances in cardiopulmonary resuscitation enable progress in management of post-cardiac arrest syndrome, but the overall prognosis after cardiac arrest has not improved. [e-jnc.org]
He has extensively published and lecture on illness severity assessment, prognosis, and early care for respiratory and airway failure, pneumonia, sepsis, heart failure and pulmonary embolism. Dr. [books.google.es]
Etiology
BACKGROUND: Postcardiac injury syndrome (PCIS) is a complication of a variety of cardiac injuries, of which small heart perforation is the etiology that is often unrecognized. [ncbi.nlm.nih.gov]
Other tests are performed based on clinical suspicion of a specific etiology or to exclude certain etiologies. [brown.edu]
Abstract Background Postcardiac injury syndrome (PCIS) is a complication of a variety of cardiac injuries, of which minor perforation of the heart with a cardiac catheter is a rare, under-recognized etiology. [circ.ahajournals.org]
Magnetic resonance imaging (MRI) may be useful when trying to establish the etiology of post-myocardial infarction pericardial effusion. 2. [file.scirp.org]
Etiology The most common form of acute pericarditis is idiopathic, which accounts for about 90% of cases ( Box 1 ). [clevelandclinicmeded.com]
Epidemiology
Epidemiology, aetiology and classification of pericardial diseases 2.1 Epidemiology 2.2 Aetiology 3. [escardio.org]
Risk Factors for PPS The earliest epidemiologic study aimed at identifying those at risk of PPS included 994 patients who underwent cardiothoracic surgery at Johns Hopkins between November of 1984-1985 12. [acc.org]
CHAPTER 48 Coronary artery bypass graft surgery 430 CHAPTER 49 Cardiogenic shock in patients with acute coronary syndromes 441 CHAPTER 50 Gender considerations in acute coronary syndromes 449 SECTION VII Acute heart failure 457 epidemiology classification [books.google.es]
The epidemiology of the postpericardiotomy syndrome: A common complication of surgery. American Heart Journal, 116, 1323–1329. PubMed CrossRef Google Scholar 5. Hargreaves, M., & Bashir, Y. (1994). [link.springer.com]
Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. [cambridge.org]
Pathophysiology
The pathophysiology of PCIS involves auto-antibodies that target antigens exposed after damage to cardiac tissue. The treatment of PCIS includes the use of nonsteroidal anti-inflammatory drugs and corticosteroids. [ncbi.nlm.nih.gov]
Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation. Circulation. 2008 Dec 2;118(23):2452-83. [lifeinthefastlane.com]
Although this matter is not recent, the pathophysiology of post-arrest adrenal insufficiency has not been elucidated. [wjgnet.com]
Post-cardiac arrest syndrome, a new term proposed by the authors of the statement, “is a unique and complex combination of pathophysiological processes,” they said. [mdedge.com]
Postcardiac injury syndrome is presumed to have autoimmune pathophysiology, triggered by the damage of pericardial or pleural mesothelial cells. 2 The syndrome is characterized by an acute pleuropericarditis consisting of fever, pleuritic chest pain, [amjmed.org]
Prevention
Several strategies (aspirin, corticosteroids, colchicine) have beenexamined in clinical trials for primary prevention of post-pericardiotomy syndrome 22 .In the COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS) trial colchicine [immunologyresearchjournal.com]
Prophylactic use of corticosteroids before cardiac surgery has not been effective in preventing PCIS. The widespread use of reperfusion therapy and cardiac medications with anti-inflammatory properties may have reduced the incidence of PCIS. [ncbi.nlm.nih.gov]
Colchicine for the prevention of postpericardiotomy syndrome. Herz. 2002 Dec;27(8):791-4. [escardio.org]
The use of colchicine for prevention of PPS has been tested in 2 large randomized control trials. [acc.org]