Postcardiac Injury Syndrome after Percutaneous Coronary Intervention

Abstract

The post cardiac injury syndrome is characterized by the development of a fever, pleuropericarditis, and parenchymal pulmonary infiltrates in the weeks following trauma to the pericardium or myocardium. According to previous reports, almost all cases develop after major cardiac surgery or a myocardial infarction. Recently, a few reports have described post cardiac injury syndrome as a complication of endovascular procedures such as percutaneous cardiac intervention. Here we describe an unusual case of post cardiac injury syndrome after a percutaneous coronary intervention.

Multimodality imaging in patients with post-cardiac injury syndrome

“…With the advent of rapid coronary revascularisation, immediate post-infarction pericarditis is reported to occur in 1.7% of cases, and late post-MI pericarditis,11 traditionally known as Dressler syndrome, occurs in <0.1% of cases 4. The incidence of pericardial complications after a PCI has recently been reported to be less than 0.2%, while other procedures such as pacemaker or defibrillator insertion have pericardial complication rates nearing 1%–2% 1 5. Post-pericardiotomy syndrome is known to occur in 10%–40% of cases after cardiac surgery.…”

“…Pericardial injuries range from myocardial infarction (MI; known as Dressler syndrome) and cardiothoracic surgery (post-pericardiotomy syndrome) to cardiac implantable electronic device placement, catheter ablations and percutaneous coronary interventions (PCI) 1. Early PCI for treatment of acute MI has led to an overall decrease in the incidence of Dressler syndrome4; however, PCI itself has also emerged as a cause of PCIS 5. Cardiac implantable electronic device placement and catheter ablation of atrial fibrillation are also known to initiate PCIS 6 7.…”

Delayed diagnosis of postcardiac injury syndrome

“…In our case, this interval was about 9 months. Among the 13 previous cases, 10 cases had fever,4 5 7 8 10 11 13 14 1 did not,6 and 2 did not mention about fever 9 12. Out of the 13 cases, 10 cases had elevated CRP,5 7–10 12–14 1 did not,11 and 2 was not described about CRP 4 6.…”

“…Among the 13 previous cases, 10 cases had fever,4 5 7 8 10 11 13 14 1 did not,6 and 2 did not mention about fever 9 12. Out of the 13 cases, 10 cases had elevated CRP,5 7–10 12–14 1 did not,11 and 2 was not described about CRP 4 6. Among 13 cases, eight cases4–7 10 12–14 had elevated ESR, with ESR data being unavailable in the remaining five cases 8 9 11 14.…”

“…A PubMed search using the key words ‘post-cardiac injury syndrome’, ‘post-pericardiotomy syndrome’, ‘post-myocardial infarction syndrome’ and ‘post-traumatic pericarditis’ identified 13 cases written in English with our required clinical data 4–14. The interval between surgery and the onset of symptoms (or hospital admission) ranged from 16 hours to 3 months in these case reports.…”