Management of pericarditis secondary to myocardial infarction

Abstract

Summary Pericarditis secondary to myocardial infarction occurs as an early, evanescent feature, with pain of pleuro-pericardial character as prominent symptom which often requires injection of analgesies. A late type of pericarditis is less frequently encountered as a complication of recent myocardial infarction. It is longer lasting, has a tendency to recur and is often associated with plenrisy and pneumonitis. Management of this complication requires primarily relief of chest and shoulder pain which are often severe, and missing only in rare instances. Corticosteroids have a dramatic effect, rapidly abolishing pain, fever and exudates. Hormonal therapy has the disadvantage that withdrawal of steroids may be followed by repeated rebounds. It is advisable to use steroids in severe, protracted cases, when pain cannot be controlled by other means or when there is rapidly spreading pneumonitis. Pericardial paracentesis is indicated when there is evidence of cardiac tamponade. Apart from this indication, aspiration of a small amount of pericardial fluid sometimes facilitates spontaneous absorption. Finally, hemorrhagic character of the aspiration fluid points to danger of continued anticoagulant therapy. Anticoagulant therapy is not contraindicated in the presence of the early, focal type of pericarditis. When, however, diffuse pericarditis is present as part of the postmyocardial infarction syndrome, one must be aware of the danger of cardiac tamponade due to hemopericardium which develops in rare instances. Once the diagnosis of diffuse pericarditis has been made, continuation of anticoagulant therapy is inadvisable unless there are reliable safeguards for early recognition and treatment of cardiac tamponade. Relief of tamponade is accomplished by paracentesis or, better, by pericardiotomy.