Pericarditis in Acute Myocardial Infarction

Abstract

In 1505 patients with acute myocardial infarction (MI) pericarditis was diagnosed most often in those with anterior transmural ECG changes. Those with pericarditis had a significantly greater hospital mortality and peak serum lactic dehydrogenase (LDH) levels and a greater incidence of left ventricular failure (LVF).

Pericarditis and Pericardial Effusion in Patients with Acute Myocardial Infarction

“…A corollary of the above is that 31 of 34 PEs in our patients were of small magnitude. Some previous work has linked PER with congestive heart failure [1, 2, 4, 13, 17], high Killip class [7,17,55], ventricular arrhythmias [1,2,3,17] and even higher mor tality [4,13,56]. Like others [5,6,10, 15], we did not detect such associations, save for a longer duration of the congestive heart failure in patients with PER, probably a reflection of their higher rate of anterior MI (tables 1, 2).…”

“…The reported incidence of PER is 6.4-41% when PFR and/or pleuritic chest pain are used in the diagnosis [1,2,8,12,21]; however, when only PFR is used, it is 6.8-28% [1-3, 7, 22], Q-wave anterior MI was more frequent than inferior in our patients with PER, as previously noted [4,8,10,11,13,17], This may be primarily due to the relationship of PER with large Mis; however, some authors have rea soned that the proximity of anterior MI to the précordium facilitates detection of PFR [3,13]. We heard PFR in 2 patients with non-Q wave MI, as previously found [10,11,13,51,52], Some workers noted PER only in patients with Q-wave MI [1][2][3][4]22], or studied only patients with Anticoagulation was not associated with PE in our patients (table 4). Concern about PE and hemopericardium with anticoagulation has been based on limited experience, and employment of oral anticoagulants, sometimes to excess [23-27, 40, 46].…”

“…This complication can emerge in the hospital or several months after discharge [1,3,15,20,22,27], There is unanimity that the prevalence of this syn drome has markedly decreased to the point that in many series, as in our cohort, no cases were detected [2,4,8,11,15,17,21], Clinical Implications PER and PE are frequent complications of acute MI. Variations in observed rates depend on the diligence implemented in their detection.…”

“…Even if transmurality is a prerequisite for PER, this complication is compatible with MI and no Q waves in the ECG, since this combination does not exclude transmurality [52,53]. A relationship of PER with large Mis has been noted [1,4,5] and was indirectly corroborated by our work (proportionally more anterior Mis in the PER cohort); however, in contrast to other reports [2, 4, 9, 13, 17, 37], we did not find higher peak creatine kinase values in the patients with than without PER [1,11]. Unlike what was reported by some authors [8,9,11,17], and in agreement with others [12], a more than double rate of PE was found in our patients with than without PER (table 2).…”

“…Anticoagulation, its influence on the emergence of PER or PE, and relationship to short-and long-term sequelae (other than post-MI syndrome or hemopericardium) have been ignored, or investigated to varying degrees [4,8,9,11,12,15]. Some information exists on PE and hemopericardium, with and without free wall car diac rupture, in patients receiving anticoagulation and in the absence of such therapy [15,[22][23][24][25][26][27],…”