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8/17/2019 Post MI Pericarditis
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Post-MI Pericarditis Dressler’s syndrome /Post Cardiotomy syndrome
-Autoimmune reaction to myocardial damage- Occur 2-10 weeks after !"MI
Clinical features#
$ecurrent fe%er&
s'ar( central c'est (ain aggra%ated )y mo%ement and lying down res(iration
$elie%ed )y leaning forward
* (leural or (ericardial ru) + )est 'eard at ,," at t'e end of e(iration wit' t'e (atientleaning forward. uiet due to massi%e (ericardial eusion w'ic' (us' t'e (ericardiuma(art
Investigation:
-"C# addle ! ele%ation +nterior and inferior.& $eci(rocal ! de(recissoon& ! wa%ede(ression
-Cardiac en3yme may ele%ated in myocarditis-C'est ray# Cardiomegaly& * Pericardial eusion& enlarged glo)ular 'eart & eclude
tu)erculous cause of (ericarditis
Treatment
4ed rest
5ig' dose oral s(irin 600mg 7-8/day
Pericarditis:
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Pericardial "usion 9 Caridiac
!em(onade Pericardial eusion# :luid collection
wit'in t'e (otentioal s(ace in t'e(ericardial sac;
Pericarditis ecess In
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Cardiac Temponade Ot'er causes of Cardiac !em(onade#
-Malignant disease& !rauma& $u(ture of Myocardial wall following MI
Clinical :eatures of Cardiac !em(onade#
Dys(noea&Colla(se& 'y(otension& !ac'ycardia&
ross ele%ation of t'e =>P& soft 'eart sound wit' an early 7rd 'eartsound&
Pulsus (aradous +,arge fall in 4P during ins(iration& ?ussmaul’s sign+ =%(@ during res(iration.&
:riedric'As sign +stee( /y descent.
In%estigation #
-"C# s'ows underlying disease of (ericarditis/ acute MI& $altrernans
-"c'ocardiogram# Diastolic colla(se of rig't atrium and %entricle reBuire urgent (ericardiocentesis
-Percardial )io(sy +sus(ected !4.
!reatment#
-Pericardiocentatsiis-Precardial fenestration+ creation of window in t'e ericardium.
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Do((ler ec'ocardiogram