| Fact | Explanation |
|---|---|
| A predisposing conditon | Postcardiotomy/pericardiotomy syndrome is a condition which, in some patients, follows a traumatic incident which results in opening of the pericardium. It is an uncommon complication of cardiac surgeries, myocardial infarction, blunt or penetrating chest trauma or procedures involving pericardiotomy. [1] [2] [3] [4] [5] [6] [7] [8] [9] The underlying pathology is development of an immune reaction the cardiac or pericardial tissue due to development of anti-heart antibodies. Presence of microbiological agents also have been studied. [10] [11] [12] The average time for onset of symptoms following a predisposing condition is around 20 days. [13] |
| Fever | Due to the inflammatory reaction. [2] [5] [9] [13] |
| Chest pain | Chest pain with relation to the inspiration phase of respiration is an important indicative factor of pericardial effusion. The pain can be exertional, radiated to abdomen, shoulders or back of the chest. [5] [6] [7] [9] [13] |
| Difficulty in breathing | Due to pleural effusion, it was present in more than half of the patients in one study. [13] |
| Arthalrgia | Due to autoimmune arthopathy. [14] |
| Fact | Explanation |
|---|---|
| Fever | Due to the inflammatory reaction. [1] [2] [3] |
| Pericardial friction rub | Due to autoimmune inflammation of the pericardium. [4] |
| Ascites | Systemic fluid collections are also common findings. [5] |
| Fact | Explanation |
|---|---|
| Endocarditis | Since the presentation is following a traumatic event to the heart, when a patient presents with fever and chest pain, one's first differential should be infective endocarditis. The usual sequence of investigations for diagnosis should be done in where it is suspected. [1] [2] |
| Congestive cardiac failure | Congestive cardiac failure can also mimic postcardiotomy syndrome following an acute myocardial infarction, the subtle clinical signs should be evaluated therefore. Echocardiogram can differentiate the two entities. [3] [4] [5] [6] [7] |
| Fact | Explanation |
|---|---|
| Complete blood count | Leucocytosis is the expected finding. [1] [2] [3] |
| Erythrocyte sedimentation rate | Increased due to inflammatory reaction. [1] [2] [4] [5] [6] |
| Anti-heart antibodies | Auto-antibodies are positive since it is an autoimmune condition. [7] [8] [9] |
| Chest X-ray | To look for evidence of pericardial and/ or pleural effusion. [3] [10] |
| Echocardiography | It is the diagnostic test. [1] [11] |
| 12 lead electrocardiogram | Might mimic pericarditis initially. [3] [12] [13] |
| Fact | Explanation |
|---|---|
| Patient education | Education of the patient regarding the diagnosis, and the good prognosis of the condition even though there can be progressive nature and recurrences. [1] [2] |
| Fact | Explanation |
|---|---|
| Non-steroidal anti-inflammatory drugs | Oral non steroidal anti inflammatory drugs usually receive a good response in milder cases. i.e. Aspirin. The dose can be reduced with the response. [1] [2] [3] |
| Corticosteroids | Given for a short course of high dose and then tapered off. |
| Intravenous immunoglobulin | Given in single high dose has the best outcome. [8] |
| Pericardiocentesis | In severe cases of pericardial effusions. Sometimes it can be life-saving. The pericardial fluid should be sent for analysis including microbiological studies. [9] [10] |