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Published on: May 28, 2019
Pericarditis and pericardial effusion in acute ST-elevation myocardial infarction in the thrombolytic era
Alp Aydinalp1, Alice Wishniak, Lily van den Akker-Berman
1Department of Cardiology, Western Galilee Hospital, Nahariya, Israel.
Insights
Acute pericarditis and effusion occurred less frequently in ST-elevation myocardial infarction (MI) patients treated with thrombolysis. Chest pain incidence was not significantly reduced, but no deaths were seen in the acute pericarditis group.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Myocardial infarction-associated pericarditis is a frequent cause of chest pain post-MI.
- Its incidence varies based on diagnostic criteria.
- Acute pericarditis and pericardial effusion are potential complications following myocardial infarction.
Purpose of the Study:
- To determine the incidence of acute pericarditis and pericardial effusion in the acute phase of ST-elevation myocardial infarction (MI).
- To assess the impact of thrombolytic therapy on these complications.
Main Methods:
- 159 consecutive acute MI patients treated with thrombolysis were studied over 18 months.
- Infarct-associated pericarditis was diagnosed by pericardial friction rub, pleuropericardial pain, or both.
- Daily physical examinations, ECGs, and echo Doppler studies were performed for 7 days.
Main Results:
- A pericardial friction rub developed in 8.8% of patients, and mild pericardial effusion in 6.9%.
- Both friction rub and effusion were present in 4.0% of patients.
- Pleuropericardial chest pain occurred in 19.5%, but only 7 had a friction rub.
Conclusions:
- Thrombolytic therapy for ST-elevation MI was associated with a lower incidence of pericardial friction rub and effusion compared to historical data.
- No significant reduction in pleuropericardial chest pain was observed.
- In-hospital mortality was low (1.3%), with no deaths in the acute pericarditis group.
Background:
Myocardial infarction-associated pericarditis is a common cause of chest pain following MI, its frequency depending on how it is defined.
Objectives:
To investigate the incidence of acute pericarditis and pericardial effusion in the acute phase of ST-elevation MI treated with thrombolytic therapy.
Methods:
The study group comprised 159 consecutive patients fulfilling the criteria for acute MI who were admitted to our department during 18 months. Infarct-associated pericarditis was defined as the finding of a pericardial friction rub, a typical pleuropericardial pain, or both. All patients underwent physical examination of the cardiovascular system four times daily for 7 days, as well as daily electrocardiogram and echo Doppler examinations.
Results:
Fourteen patients (8.8%) developed a friction rub and 11 patients (6.9%) had a mild pericardial effusion. Six patients (4.0%) had both a friction rub and pericardial effusion. Two patients had a friction rub for more than 7 days. Pleuropericardial chest pain was present in 31 patients (19.5%) but only 7 of them had a friction rub. The in-hospital mortality rate was 1.3% and no mortality was observed in the acute pericarditis group.
Conclusion:
The incidence of signs associated with acute pericarditis was lower in MI patients treated with thrombolysis, compared with historical controls, when a friction rub and/or pericardial effusion was present. There was no significant reduction in the incidence of pleuropericardial chest pain.
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