The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Case Report

The Postcardiac Injury Syndrome: Case Report and Review of the Literature

Authors: Dylan E. Wessman, MD, Christopher M. Stafford, MD

Abstract

The postcardiac injury syndrome (PCIS) includes the postmyocardial infarction syndrome, the postcommissurotomy syndrome, and the postpericardiotomy syndrome. Dressler reported a series of patients who developed a pericarditis-like illness days to weeks after a myocardial infarction. Postcardiac injury syndrome also has been observed after cardiac surgery, percutaneous intervention, pacemaker implantation, and radiofrequency ablation.


Postcardiac injury syndrome is characterized by pleuritic chest pain, low-grade fever, an abnormal chest x-ray, and the presence of exudative pericardial and/or pleural effusions. The pathophysiology of PCIS involves auto-antibodies that target antigens exposed after damage to cardiac tissue.


The treatment of PCIS includes the use of nonsteroidal anti-inflammatory drugs and corticosteroids. Prophylactic use of corticosteroids before cardiac surgery has not been effective in preventing PCIS. The widespread use of reperfusion therapy and cardiac medications with anti-inflammatory properties may have reduced the incidence of PCIS. Although PCIS can follow a relapsing course, it does carry a favorable prognosis.


Key Points


* The postcardiac injury syndrome includes the postmyocardial infarction syndrome, the postcommissurotomy syndrome, and the postpericardiotomy syndrome.


* Postcardiac injury syndrome is characterized by pleuritic chest pain, low-grade fever, an elevated erythrocyte sedimentation rate, an abnormal chest radiograph, and the presence of exudative pericardial and/or pleural effusions.


* The proposed pathophysiology of postcardiac injury syndrome involves auto-antibodies that target antigens exposed after damage to cardiac tissue.


* The treatment of postcardiac injury syndrome includes the use of both nonsteroidal anti-inflammatory drugs and corticosteroids.


* Although postcardiac injury syndrome can follow a relapsing course, it does carry a favorable prognosis.

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