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pericarditis after a heart attack

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Heart attack

Alternative Names 
post-MI pericarditis, post myocardial infarction pericarditis

After a heart attack, the thin lining that surrounds the heart may become inflamed or irritated. This condition is known as pericarditis.

What is going on in the body? 
The lining or sac that surrounds the heart is called the pericardium. A heart attack that injures the entire thickness of the heart can sometimes irritate and inflame the heart sac.

What are the signs and symptoms of the condition? 
Symptoms usually appear a few hours to a week after a heart attack. However, in some cases, the symptoms do not occur until several weeks or even months later. The most common symptom is chest pain. Often, the pain is mild. Many people only have chest pain when asked to inhale deeply. Others may have pain when they move or change body positions. Joint pains and mild fever may also occur.

The doctor with a stethoscope can sometimes hear a sound called a friction rub when this condition occurs. This scratchy sound is made when the surface of the heart and the inflamed heart lining rub together.

What are the causes and risks of the condition? 
A heart attack causes this condition. Those with larger heart attacks are more likely to develop this condition. Other causes of pericarditis include a bacterial infection, which causes bacterial pericarditis, and adhesions, which cause constrictive pericarditis.

What can be done to prevent the condition? 
There are no known ways to prevent this condition after a heart attack. A person with known heart disease should be seen by the doctor regularly to lower the risk of a heart attack.

How is the condition diagnosed? 
Diagnosis starts with a history and physical examination. This is often enough to make the diagnosis, especially when the friction rub sound is present. An ECG, or heart tracing, will be done. This can aid in the diagnosis and help make sure the person is not having another heart attack. Blood tests, including tests called a full blood count, or FBC, and erythrocyte sedimentation rate, are often done as well.

An imaging test, called an echocardiogram, uses ultrasound waves to see the heart and may also help make the diagnosis in some cases.

What are the long-term effects of the condition? 
In most cases, this condition causes few or no long-term effects. In some people, this condition may come back several times with severe pain, but it usually responds to treatment each time.

What are the risks to others? 
There are no risks to others.

What are the treatments for the condition? 
Pericarditis after a heart attack usually responds to a short course of aspirin, or other anti-inflammatory drugs called NSAIDs. Stronger analgesics, such as the narcotic morphine, are given if needed. In severe or repeat cases, corticosteroid medications such as prednisone may be given.

What are the side effects of the treatments? 
Aspirin and NSAIDs may cause allergic reactions, stomach upset, or kidney damage. Narcotics can cause constipation, stomach upset, and allergic reactions. Corticosteroids can cause weight gain, depression, and other side effects.

What happens after treatment for the condition? 
Most episodes of pericarditis after a heart attack resolve by themselves and need no further treatment. The focus is usually on treating the underlying heart disease. In some cases, treatment may be needed in the future for repeated episodes of pericarditis.

How is the condition monitored? 
If the symptoms go away, the only needed monitoring is for the underlying heart disease. Someone who has had a heart attack needs close monitoring and treatment to prevent a second heart attack. Any new or worsening symptoms should be reported to the doctor.

Author: Eric Berlin, MD
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 24/11/2004
Potential conflict of interest information for reviewers available on request

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