Post-Cardiac Injury Syndrome (PCIS)

(aka Post-Pericardiotomy syndrome, Post-Pericardiectomy Syndrome, Post-MI Syndrome, Dressler’s Syndrome)

Epidemiology

  • Time of Onset: usually develops about 3 weeks (range: 3 weeks-1 year) after inciting event
  • Incidence: 1% after MI

Etiology

  • Blunt Chest Trauma:
  • Post-MI (see [[Coronary Artery Disease]])
  • Post-Cardiac Surgery:
  • Percutaneous LV Puncture:
  • Post-Pacemaker Placement:

Physiology

  • Injury to myocardium or pericardium -> immunologic mechanism (anti-heart antibodies can be detected, although it is unclear as to their role)

Diagnosis

  • CBC: leukocytosis
  • ESR: elevated
  • Pleural Fluid:
    • Appearance: serosanguineous or bloody
    • Exudate
    • Glucose: >60 mg/dL
    • pH: >7.5
    • Cell Count and Diff: either PMN-predominant to mononuclear-predominent (depending on acuity of the process)

Clinical Features

Cardiac Manifestations

  • Chest Pain
    • Usually precedes onset of fever
    • Varies from dull ache-agonizing crushing chest pain
    • May be pleuritic
  • Pericardial Rub: may be present
  • Pericardial Effusion
  • Occlusion of CABG Grafts: may occur

Pulmonary Manifestations

  • Pleuritis/Pleural Effusion (see [[Pleural Effusion-Exudate]])
    • Effusion occurs in 66% of cases
    • Effusions are usually bilateral and small
  • Pneumonitis: pulmonary infiltrates present in 50% of cases

Constitutional Manifestations

  • Fever

Treatment

  • NSAID’s
    • ASA, indomethacin
    • Usually effective
  • Corticosteroids
    • May be necessary for more severe cases
    • May be required to prevent occlusion of CABG grafts

References

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