Clinical Significance of Pericardial Effusion Associated With Pericarditis in Acute Q-wave Anterior Myocardial Infarction

Sugiura, Tetsuro; Iwasaka, Toshiji; Nagahama, Yo; Taniguchi, Hiroya; Inada, Mitsuo

doi:10.1378/chest.104.2.415

Cited by 7 publications

(10 citation statements)

References 25 publications

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“…3 However, a similar study detected a pericardial rub in 65 out of 303 (21%) patients following AMI. 7 Postinfarct pericarditis has been reported in as many as 25% of AMI patients when the diagnosis is contingent upon the presence of a pericardial rub and/or pericardial chest pain. Diagnosing pericardial inflammation on the basis of positional chest pain likely results in the overestimation of its frequency.…”

Section: Infarct-associated Pericarditismentioning

confidence: 99%

“…2 Among 65 patients with pericarditis following AMI, a pericardial effusion was detected in only 27 patients (42%). 7 An echo is capable of detecting an excess of 50 ml of pericardial fluid, and a value >50 ml of fluid suggests an abnormal pericardial effusion rather than a physiologic one. 8 In AMI patients with congestive heart failure (CHF) or elevated right-sided filling pressures, fluid may accumulate in the pericardial sac when hydrostatic pressure is increased and hemodynamics are impaired.…”

Section: Infarct-associated Pericarditismentioning

confidence: 99%

“…2,8 Postinfarct pericardial effusions are usually mild (78%-88%) to moderate (12%-22%) in size, 7,8 and circular effusions are rare occurring in less than 4% of cases. 2 A large effusion with evidence of tamponade physiology following AMI suggests possible cardiac rupture.…”

Section: Infarct-associated Pericarditismentioning

confidence: 99%

“…2 In the setting of pericarditis, an effusion is not caused primarily by abnormal hemodynamics as right atrial pressure, pulmonary artery wedge pressure, and cardiac output are similar for patients with and without effusions. 5,7 In fact, AMI patients with pericardial effusions and pericardial friction rubs frequently have significantly lower pulmonary artery capillary wedge pressures as compared to those with effusions without a friction rub. 5 Rather, pericardial effusions in the setting of postinfarct pericarditis occur due to increased production of interstitial fluid, obstruction of lymphatic drainage, or an increase in capillary permeability.…”

Section: Infarct-associated Pericarditismentioning

confidence: 99%

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Regional Pericarditis: A Review of the Pericardial Manifestations of Acute Myocardial Infarction

Dorfman

Aqel

2009

Clinical Cardiology

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Regional pericarditis has been described in several settings, but occurs most frequently after transmural myocardial infarction. While the diagnosis remains elusive, it must be considered in all patients with recurrent chest pain following acute myocardial infarction (AMI). Pericarditis classically presents with positional chest pain, a pericardial friction rub, diffuse ST-segment elevation, and PR depression, but regional ECG changes associated with infarction-associated pericarditis sometimes exist. Given the magnitude and frequency of AMI, it is imperative to be aware of the myriad of pericardial manifestations of myocardial injury. An illustrative case and a comprehensive review of the literature will be provided.Key words: regional pericarditis, infarction-associated pericarditis, pericardial effusion Introduction A 53-year-old white male presented to the emergency department with severe chest pain associated with dyspnea, diaphoresis, nausea, and presyncope which was alleviated minimally by nitroglycerin and morphine. His ECG was suggestive of a posterior-lateral infarct (Figure 1), and the patient was taken emergently to the catheterization lab. Coronary angiography revealed a complete occlusion of the proximal left circumflex (LCx) coronary artery with a thrombus and TIMI 0 flow (Figure 2). Angiography was also notable for severe right coronary artery (RCA) disease (Figure 3). After clot extraction, the patient underwent successful LCx percutaneous coronary intervention (PCI) and stenting with restoration of TIMI 3 flow, and his STsegments resolved. The patient was also treated with dual anti-platelet therapy, heparin, and a glycoprotein (GP) IIbIIIa inhibitor. Cardiac enzymes peaked with a CK of 4373 U/L, a CK-MB of 283 ng/ml, and a troponin I level of 516.4 ng/ml.Within 24 h of his initial presentation, the patient began experiencing severe chest pain with recurrent ST-segment elevation in the inferior and lateral leads (Figure 4). Repeat coronary angiography was unchanged from the previous study, and the LCx stent remained patent with TIMI 3 flow ( Figure 5). The patient underwent a successful PCI of his distal RCA without resolution of his chest pain or ECG. Transthoracic echocardiography (TTE) revealed hypokinesis of the inferior and lateral walls and akinesis of the posterior walls, mild left ventricular (LV) dysfunction, and a mild-to moderate-sized pericardial effusion without evidence of tamponade physiology (Figure 6).

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Section: Infarct-associated Pericarditismentioning

confidence: 99%

Section: Infarct-associated Pericarditismentioning

confidence: 99%

Section: Infarct-associated Pericarditismentioning

confidence: 99%

Section: Infarct-associated Pericarditismentioning

confidence: 99%

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Regional Pericarditis: A Review of the Pericardial Manifestations of Acute Myocardial Infarction

Dorfman

Aqel

2009

Clinical Cardiology

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“…In this regard, characteristic description of the non-complicated regional pericardial fluid that helps differentiate the true "risky components" may help therapeutic strategy decision. So far, regional pericarditis manifested as hemopericardium remained as a rare complication following large, transmural ventricular infarction [12]. Oliva and Mayo ever reported the atypical ECG natures with such regional pericarditis following MI, and so far there is no standardized ECG criteria in such clinical setting [3].…”

Section: Discussionmentioning

confidence: 99%

Localized pericarditis leading to clinical tamponade with profound shock status and syncope as a major clinical manifestation after posterior wall myocardial infarction—Characterization and descriptive findings by real-time 3-dimensional echocardiography

Chi¹,

Lo²,

Hou³

et al. 2013

CRCM

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Pericarditis and hemopericardium causing cardiac tamponade, caused by large and transmural ventricular infarction with subsequent rupture into the pericardium, is a rare complication post acute myocardial infarction. This is frequently fatal with rapid clinical course. We reported a 65-year-old female who presented with persistent diaphoresis and dyspnea for several hours followed by syncope. Acute myocardial infarction was diagnosed with primary percutaneous coronary intervention performed though persistent hypotension was observed. Moderate amount of hemopericardium leading to tamponade was found. It was relieved after pericardiocentesis. Real-time three-dimensional echocardiography revealed blood clot with specific whirling pattern around the infracted ventricular wall with suspected leak.

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Pericardial involvement in acute myocardial infarction in the post‐thrombolytic era: Clinical meaning and value

Correale

Romano²,

Ricciardiello³

et al. 1997

Clinical Cardiology

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Summary: Pericardial involvement (PI) in acute myocardialinfarction (AMI) is a complication usually considered benign and has therefore received less attention than those more severe. It may be easily missed because it presents few symptoms and signs, which in turn may be confused with those of AMI. Its pathophysiology, diagnosis, and pitfalls are discussed. The GISSI-1 trial revealed a marked reduction of PI in the group treated with thrombolysis. This unexpected finding was later confirmed by the GISSI-2 trial and by other studies, drawing attention to its meaning. Data from the GISSI as well as from other studies have been reviewed and seem to indicate that PI is associated with larger AMIs and with a significant increase in 6-and 12-month mortality. This may be attributed to the consequences of late remodeling of a large infarction. These findings lead to the conclusion that PI should be granted more attention, and that it might identify patients with apoorer long-term outcome.

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Clinical Significance of Pericardial Effusion Associated With Pericarditis in Acute Q-wave Anterior Myocardial Infarction

Cited by 7 publications

References 25 publications

Regional Pericarditis: A Review of the Pericardial Manifestations of Acute Myocardial Infarction

Regional Pericarditis: A Review of the Pericardial Manifestations of Acute Myocardial Infarction

Localized pericarditis leading to clinical tamponade with profound shock status and syncope as a major clinical manifestation after posterior wall myocardial infarction—Characterization and descriptive findings by real-time 3-dimensional echocardiography

Pericardial involvement in acute myocardial infarction in the post‐thrombolytic era: Clinical meaning and value

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