Skip to main content
SpringerLink
Log in

Pericarditis and Post-cardiac Injury Syndrome as a Sequelae of Acute Myocardial Infarction

  • Pericardial Disease (L Klein and CL Jellis, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Pericarditis secondary to acute myocardial infarction (AMI) is known to develop either immediately or after a latent period of few months. Due to varied presentation and timing, its diagnosis and treatment can be challenging. This article reviews underlying mechanisms and the role of cardiac imaging in investigating and managing this condition.

Recent Findings

Timely diagnosis of pericarditis after AMI is important to prevent potential progression to complicated pericarditis. Clinical suspicion warrants initial investigation with serum inflammatory levels, electrocardiogram, and echocardiography. When findings are inconclusive, cardiac magnetic resonance imaging and computerized tomography can provide additional diagnostic information.

Summary

Pericarditis after AMI is a treatable condition. Clinicians should maintain a high suspicion in this era of revascularization and develop a strategic plan for timely diagnosis and management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AMI:

Acute myocardial infarction

CMR:

Cardiac magnetic resonance

CRP:

C-reactive protein

CT:

Computerized tomography

DHE:

Delayed hyperenhancement

ESC:

European Society of Cardiology

ESR:

Erythrocyte sedimentation rate

PCI:

Percutaneous coronary intervention

PEff:

Pericardial effusion

PIP:

Post infarction pericarditis

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, et al. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease. J Am Soc Echocardiogr. 2013;26(9):965–1012.e15 Available from: https://linkinghub.elsevier.com/retrieve/pii/S0894731713005336. Accessed 3 August 2020.

  2. Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015;36(42):2921–64.

    PubMed  Google Scholar 

  3. Tofler GH, Muller JE, Stone PH, Willich SN, Davis VG, Poole WK, et al. Pericarditis in acute myocardial infarction: characterization and clinical significance. Am Heart J. 1989;117(1):86–92 Available from: http://www.ncbi.nlm.nih.gov/pubmed/2643287. Accessed 3 August 2020.

  4. Dressler W. A post-myocardial infarction syndrome; preliminary report of a complication resembling idiopathic, recurrent, benign pericarditis. J Am Med Assoc. 1956;160(16):1379–83 Available from: http://www.ncbi.nlm.nih.gov/pubmed/13306560. Accessed 3 August 2020.

  5. Bendjelid K, Pugin J. Is Dressler syndrome dead? Chest. 2004;126(5):1680–2.

    PubMed  Google Scholar 

  6. • Verma BR, Chetrit M, Gentry JL III, Noll A, Bafadel A, Khayata M, et al. Multimodality imaging in patients with post-cardiac injury syndrome. Heart. 2020;106(9):639–46 This article provides important information about the role of multi-modality imaging in the management of pericardial diseaseas caused by injury to the pericardial tissue due to cardiac surgery, myocardial infarction or iatrogenic causes such as catheter ablation.

    PubMed  Google Scholar 

  7. Imazio M, Negro A, Belli R, Beqaraj F, Forno D, Giammaria M, et al. Frequency and prognostic significance of pericarditis following acute myocardial infarction treated by primary percutaneous coronary intervention. Am J Cardiol. 2009;103(11):1525–9. Available from:. https://doi.org/10.1016/j.amjcard.2009.01.366. Accessed 3 August 2020.

  8. Gamoudi D, Gamoudi N, Bugeja V, Vella A. An atypical case of post cardiac injury syndrome following an elective percutaneous coronary intervention. Eur Geriatr Med. 2015;6(6):589–90.

    Google Scholar 

  9. Elbaz-Greener G, Wijeysundera HC. A presentation of postcardiac injury syndrome after successful chronic total occlusion percutaneous coronary intervention using dissection re-entry techniques. Clin Case Rep. 2017;5(6):855–8.

    PubMed  PubMed Central  Google Scholar 

  10. Gungor B, Ucer E, Erdinler IC. Uncommon presentation of postcardiac injury syndrome: acute pericarditis after percutaneous coronary intervention. Int J Cardiol. 2008;128(1):e19–21 Available from: https://linkinghub.elsevier.com/retrieve/pii/S016752730701248X. Accessed 3 August 2020.

  11. Park J-S, Kim D-H, Choi W-G, Woo S-I, Kwan J, Park K-S, et al. Postcardiac injury syndrome after percutaneous coronary intervention. Yonsei Med J. 2010;51(2):284–6.

    PubMed  PubMed Central  Google Scholar 

  12. Alraies MC, Al Jaroudi W, Shabrang C, Yarmohammadi H, Klein AL, Tamarappoo BK. Clinical features associated with adverse events in patients with post-pericardiotomy syndrome following cardiac surgery. Am J Cardiol. 2014;114(9):1426–30 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316687/pdf/nihms-629463.pdf. Accessed 3 August 2020.

  13. Tamarappoo BK, Klein AL. Post-pericardiotomy syndrome. Curr Cardiol Rep. 2016;18(11):116. Available from:. https://doi.org/10.1007/s11886-016-0791-0.

    Article  PubMed  Google Scholar 

  14. Imazio M, Brucato A, Ferrazzi P, Pullara A, Adler Y, Barosi A, et al. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA. 2014;312(10):1016–23.

    CAS  PubMed  Google Scholar 

  15. Doulaptsis C, Goetschalckx K, Masci PG, Florian A, Janssens S, Bogaert J. Assessment of early post-infarction pericardial injury by CMR. JACC Cardiovasc Imaging. 2013;6:411–3.

    PubMed  Google Scholar 

  16. Bogaert J, Francone M. Pericardial disease: value of CT and MR imaging. Radiology. 2013;267(2):340–56 Available from: http://radiology.rsna.org/lookup. Accessed 3 August 2020.

  17. Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol. 2013;168(2):648–52.

    PubMed  Google Scholar 

  18. Sedaghat-Hamedani F, Zitron E, Kayvanpour E, Lorenz HM, Katus HA, Meder B. Post cardiac injury syndrome after initially uncomplicated CRT-D implantation: a case report and a systematic review. Clin Res Cardiol. 2014;103(10):781–9.

    PubMed  Google Scholar 

  19. Cremer PC, Kumar A, Kontzias A, Tan CD, Rodriguez ER, Imazio M, et al. Complicated pericarditis: understanding risk factors and pathophysiology to inform imaging and treatment. J Am Coll Cardiol. 2016;68(21):2311–28.

    PubMed  Google Scholar 

  20. Holt JP. The normal pericardium. Am J Cardiol. 1970;26(5):455–65 Available from: http://www.ncbi.nlm.nih.gov/pubmed/4991283.

    CAS  PubMed  Google Scholar 

  21. Kligerman S. Imaging of pericardial disease. Radiol Clin N Am. 2019;57(1):179–99.

    PubMed  Google Scholar 

  22. Rodriguez ER, Tan CD. Structure and anatomy of the human pericardium. Prog Cardiovasc Dis. 2017;59(4):327–40.

    PubMed  Google Scholar 

  23. Hoit BD. Anatomy and physiology of the pericardium. Cardiol Clin. 2017;35(4):481–90.

    PubMed  Google Scholar 

  24. Erlich JF, Paz Z. Postpericardial injury syndrome: an autoimmune phenomenon. Clin Rev Allergy Immunol. 2010;38(2–3):156–8.

    PubMed  Google Scholar 

  25. Fredrick J, Shoen RNM. The heart. In: Kumar V, Abbas AK, JCA NF, editors. Pathologic Basis of Disease. Eigth ed. Philadelphia: Saunders, Elsevier; 2011. p. 581–3.

    Google Scholar 

  26. •• Chetrit M, Xu B, Kwon DH, Ramchand J, Rodriguez RE, Tan CD, et al. Imaging-guided therapies for pericardial diseases. JACC Cardiovasc Imaging. 2020;13(6):1422–37 Findings from this article provides a comprehensive approach for the diagnosis and treatment of pericardial diseases using multi-modality imaging such as echocardiography, computerized tomography and cardiac magnetic resonance imaging.

    PubMed  Google Scholar 

  27. Dorfman TA, Aqel R. Regional pericarditis: a review of the pericardial manifestations of acute myocardial infarction. Clin Cardiol. 2009;32(3):115–20.

    PubMed  PubMed Central  Google Scholar 

  28. Gurunathan S, Parsons G, Young G, Porter A, Elghamaz A, Senior R. Postcardiac injury syndrome: a rare complication of elective coronary angioplasty. Am J Med. 2016;129(5):e13–4.

    PubMed  Google Scholar 

  29. Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM, et al. Pericardial disease: diagnosis and management. Mayo Clin Proc. 2010;85(6):572–93.

    PubMed  PubMed Central  Google Scholar 

  30. Goyle KK, Walling AD. Diagnosing pericarditis. Am Fam Physician. 2002;66(9):1695–702.

    PubMed  Google Scholar 

  31. Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P. Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis. Eur Heart J. 2000;21(10):832–6.

    CAS  PubMed  Google Scholar 

  32. Imazio M, Demichelis B, Cecchi E, Belli R, Ghisio A, Bobbio M, et al. Cardiac troponin I in acute pericarditis. J Am Coll Cardiol. 2003;42(12):2144–8.

    CAS  PubMed  Google Scholar 

  33. Melo DTP, Fernandes F, Salemi VMC, Buck PC, Dias RR, Tiveron MG, et al. Diagnostic challenge in constrictive pericarditis: the role of brain natriuretic peptide and image tools. Eur Heart J. 2013;34(suppl 1):P3893.

    Google Scholar 

  34. Ala CK, Banerjee K, Chahine J, Verma B, Kumar A, Furqan M, et al. D-dimer as a novel marker of inflammation in pericarditis. J Am Coll Cardiol. 2019;73(9 Supplement 1):984 Available from: http://www.onlinejacc.org/content/73/9_Supplement_1/984.abstract. Accessed 3 August 2020.

  35. Spodick DH. Pericardial disease. In: Essential cardiology. Totowa: Humana Press; 2005. p. 653–9.

    Google Scholar 

  36. Troughton RW, Asher CR, Klein AL. Pericarditis. Lancet. 2004;363(9410):717–27.

    PubMed  Google Scholar 

  37. Imazio M, Adler Y. Management of pericardial effusion. Eur Heart J. 2013;34(16):1186–97.

    PubMed  Google Scholar 

  38. Leitman M, Tyomkin V, Peleg E, Copel L, Vered Z, FACC F. Left ventricular function in acute inflammatory peri-myocardial diseases - new insights and long-term follow-up. Cardiovasc Ultrasound. 2012;10(42) Available from: http://www.ncbi.nlm.nih.gov/pubmed/23121688. Accessed 3 August 2020.

  39. Esmaeilzadeh M, Parsaee M, Maleki M. The role of echocardiography in coronary artery disease and acute myocardial infarction. J Tehran Heart Cent. 2013 Jan;8(1):1–13.

    PubMed  PubMed Central  Google Scholar 

  40. Gentry J, Klein AL, Jellis CL. Transient constrictive pericarditis: current diagnostic and therapeutic strategies. Curr Cardiol Rep. 2016;18:1–9.

    Google Scholar 

  41. Zurick AO, Bolen MA, Kwon DH, Tan CD, Popovic ZB, Rajeswaran J, et al. Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation. JACC Cardiovasc Imaging. 2011;4(11):1180–91. Available from:. https://doi.org/10.1016/j.jcmg.2011.08.011.

    Article  PubMed  Google Scholar 

  42. Bogaert J, Francone M. Cardiovascular magnetic resonance in pericardial diseases. J Cardiovasc Magn Reson. 2009;11(1):1–14.

    Google Scholar 

  43. Kumar A, Sato K, Verma BR, Ala CK, Betancor J, Yzeiraj E, et al. Quantitative assessment of pericardial delayed hyperenhancement helps identify patients with ongoing recurrences of pericarditis. Open Heart. 2018;5(2):e000944.

    PubMed  PubMed Central  Google Scholar 

  44. Yared K, Baggish AL, Picard MH, Hoffmann U, Hung J. Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging. 2010;3(6):650–60 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20541720. Accessed 3 August 2020.

  45. Verhaert D, Gabrie RS, Johnston D, Lytle BW, Desai MY, Klein AL. The role of multimodality imaging in the management of pericardial disease. Circ Cardiovasc Imaging. 2010;3(3):333–43.

    PubMed  Google Scholar 

  46. Aletras AH, Tilak GS, Natanzon A, Hsu L-Y, Gonzalez FM, Hoyt RF, et al. Retrospective determination of the area at risk for reperfused acute myocardial infarction with T2-weighted cardiac magnetic resonance imaging: histopathological and displacement encoding with stimulated echoes (DENSE) functional validations. Circulation. 2006;113(15):1865–70.

    PubMed  Google Scholar 

  47. Friedrich MG, Abdel-Aty H, Taylor A, Schulz-Menger J, Messroghli D, Dietz R. The salvaged area at risk in reperfused acute myocardial infarction as visualized by cardiovascular magnetic resonance. J Am Coll Cardiol. 2008;51(16):1581–7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18420102. Accessed 3 August 2020.

  48. Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, Cooper LT, et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol. 2009;53(17):1475–87 Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735109709004963. Accessed 3 August 2020.

  49. Kumar A, Sato K, Yzeiraj E, Betancor J, Lin L, Tamarappoo BK, et al. Quantitative pericardial delayed hyperenhancement informs clinical course in recurrent pericarditis. JACC Cardiovasc Imaging. 2017;10(11):1337-1346.Available from: http://www.ncbi.nlm.nih.gov/pubmed/28330665.

  50. Cremer PC, Tariq MU, Karwa A, Alraies MC, Benatti R, Schuster A, et al. Quantitative assessment of pericardial delayed hyperenhancement predicts clinical improvement in patients with constrictive pericarditis treated with anti-inflammatory therapy. Circ Cardiovasc Imaging. 2015;8(5):1–7.

    Google Scholar 

  51. Francone M, Carbone I, Agati L, Bucciarelli Ducci C, Mangia M, Iacucci I, et al. Utility of T2-weighted short-tau inversion recovery (STIR) sequences in cardiac MRI: an overview of clinical applications in ischaemic and non-ischaemic heart disease. Radiol Med. 2011;116(1):32–46 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20927650.

    CAS  PubMed  Google Scholar 

  52. Abdel-Aty H, Zagrosek A, Schulz-Menger J, Taylor AJ, Messroghli D, Kumar A, et al. Delayed enhancement and T2-weighted cardiovascular magnetic resonance imaging differentiate acute from chronic myocardial infarction. Circulation. 2004;109(20):2411–6.

    PubMed  Google Scholar 

  53. Meng X, Yang Y-K, Yang K-Q, Zhang Y, Lu P-P, Fan P, et al. Clinical characteristics and outcomes of left ventricular pseudoaneurysm: a retrospective study in a single-center of China. Medicine (Baltimore). 2017;96(18):e6793.

    Google Scholar 

  54. Delille JP, Hernigou A, Sene V, Chatellier G, Boudeville JC, Challande P, et al. Maximal thickness of the normal human pericardium assessed by electron-beam computed tomography. Eur Radiol. 1999;9(6):1183–9.

    CAS  PubMed  Google Scholar 

  55. Imazio M, Lazaros G, Brucato A, Gaita F. Recurrent pericarditis: new and emerging therapeutic options. Nat Rev Cardiol. 2016;13(2):99–105.

    CAS  PubMed  Google Scholar 

  56. Khayata M, Shah NP, Verma BR, Giugni AS, Alkharabsheh S, Asher CR, et al. Usefulness of Interleukin-1 Receptor Antagonists in Patients With Recurrent Pericarditis. Am J Cardiol [Internet]. 2020 Jul 15;127:184–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32416963.

  57. •• Klein A, Imazio M, Brucato A, et al. RHAPSODY: Rationale for and Design of a Pivotal Phase 3 Trial to Assess Efficacy and Safety of Rilonacept, an IL-1α and IL-1β trap, in Patients with Recurrent Pericarditis, American Heart Journal (2020), https://doi.org/10.1016/j.ahj.2020.07.004. This clinical trial provides important information about the efficacy and safety profile of a newer drug - rilonacept in the treatment of recurrent pericarditis.

  58. Gillaspie EA, Dearani JA, Daly RC, Greason KL, Joyce LD, Oh J, et al. Pericardiectomy after previous bypass grafting: analyzing risk and effectiveness in this rare clinical entity. Ann Thorac Surg. 2017;103(5):1429–33 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27825685.

    PubMed  Google Scholar 

  59. Smith SC, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update. Circulation. 2011;124(22):2458–73. Available from:. https://doi.org/10.1161/CIR.0b013e318235eb4d.

    Article  PubMed  Google Scholar 

  60. Giugliano GR, Giugliano RP, Gibson CM, Kuntz RE. Meta-analysis of corticosteroid treatment in acute myocardial infarction. Am J Cardiol. 2003;91(9):1055–9.

    CAS  PubMed  Google Scholar 

  61. Raposo L, Andrade MJ, Ferreira J, Aguiar C, Couto R, Abecasis M, et al. Subacute left ventricle free wall rupture after acute myocardial infarction: awareness of the clinical signs and early use of echocardiography may be life-saving. Cardiovasc Ultrasound. 2006;4:1–9.

    Google Scholar 

  62. Vaduganathan M, Bhatt DL, Cryer BL, Liu Y, Hsieh W-H, Doros G, et al. Proton-pump inhibitors reduce gastrointestinal events regardless of aspirin dose in patients requiring dual antiplatelet therapy. J Am Coll Cardiol. 2016;67(14):1661–71 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27012778.

    CAS  PubMed  Google Scholar 

  63. Yadlapati R, Kahrilas PJ. When is proton pump inhibitor use appropriate? BMC Med. 2017;15(1):1–4.

    Google Scholar 

  64. Syed FF, Schaff HV, Oh JK. Constrictive pericarditis—a curable diastolic heart failure. Nat Rev Cardiol. 2014;11(9):530–44. Available from:. https://doi.org/10.1038/nrcardio.2014.100.

    Article  PubMed  Google Scholar 

  65. Murashita T, Schaff HV, Daly RC, Oh JK, Dearani JA, Stulak JM, et al. Experience with pericardiectomy for constrictive pericarditis over eight decades. Ann Thorac Surg. 2017;104(3):742–50. Available from:. https://doi.org/10.1016/j.athoracsur.2017.05.063.

    Article  PubMed  Google Scholar 

  66. Haley JH, Tajik AJ, Danielson GK, Schaff HV, Mulvagh SL, Oh JK. Transient constrictive pericarditis: causes and natural history. J Am Coll Cardiol. 2004;43(2):271–5 Available from:. https://doi.org/10.1016/j.jacc.2003.08.032.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Center for Diagnosis and Treatment of Pericardial Disease, Cleveland Clinic, 9500 Euclid Ave., Desk J1-5, Cleveland, OH, USA

    Beni R. Verma, Bryce Montane, Michael Chetrit, Mohamed Khayata, Muhammad M. Furqan, Chadi Ayoub & Allan L. Klein

Authors
  1. Beni R. Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bryce Montane
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Chetrit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed Khayata
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Muhammad M. Furqan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chadi Ayoub
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Allan L. Klein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allan L. Klein.

Ethics declarations

Conflict of Interest

Beni R. Verma, Bryce Montane, Michael Chetrit, Mohamed Khayata, Muhammad M. Furqan, and Chadi Ayoub declare that they have no conflict of interest.

Allan L. Klein receives honorarium from the Sobi and Pfizer Pharmaceuticals. Also, he receives a research grant from the Kiniksa Pharmaceuticals. He is on the scientific advisory board for Sobi, Pfizer and Kiniksa Pharmaceuticals.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Pericardial Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Verma, B.R., Montane, B., Chetrit, M. et al. Pericarditis and Post-cardiac Injury Syndrome as a Sequelae of Acute Myocardial Infarction. Curr Cardiol Rep 22, 127 (2020). https://doi.org/10.1007/s11886-020-01371-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-020-01371-5

Keywords

Search

Navigation