Editorial

Are We Missing Something? What Really Is the Post Cardiotomy Syndrome?

Authors: George Ritter, MD, FACP, FACC

Abstract

Wessman and Stafford1 in this issue of the SMJ review the conundrum of the post–cardiac injury syndrome (PCIS). Many physicians have said that since we treat the myocardial infarction (MI) patients so aggressively, we minimize muscle damage, hence the syndrome is rarely seen. We did an informal and unscientific survey of cardiologists at a recent meeting and this was the consensus. However, one Chief of Cardiology stated that 10 to 25% of postoperative cardiac surgery patients develop variations of the syndrome, due to the pericardium being opened. A retired cardiac surgeon reported seeing 5 to 10% of cases postoperatively. Mott et al2 reported that of 246 children who had cardiac surgery, 39% had PCIS. In 1953, Soloff3 felt that mitral commissurotomy caused rheumatic fever to be reactivated. The classical picture as described in 1958 by Dressler4 included chest pain, fever, fatigue, myalgia, arthralgia pericardial friction rub with effusion and pleuritis. The electrocardiogram (EKG) was nondiagnostic, but there was an elevated sedimentation rate (ESR) and C-reactive protein (CRP) level. It usually began from a few days postinfarct to several weeks or months and generally responded well to steroids. It had a variable course length (weeks to months) with minimal sequelae. He reported one death due to cardiac tamponade.

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