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Factors associated with pericardial effusion in acute Q wave myocardial infarction
T Sugiura1, T Iwasaka, Y Takayama
1Second Department of Internal Medicine Kansai Medical University, Osaka, Japan.
Insights
Early myocardial infarction can cause pericardial effusion. Hemodynamic factors are linked to effusion without a rub, while increased microvascular permeability is associated with effusion and rub, impacting cardiac health.
Area of Science:
- Cardiology
- Internal Medicine
- Pathophysiology
Background:
- Pericardial effusion is a potential complication of acute myocardial infarction (MI).
- Understanding the clinical characteristics and underlying mechanisms of pericardial effusion in early MI is crucial for patient management.
Purpose of the Study:
- To identify clinical factors associated with pericardial effusion in the early phase of acute Q wave myocardial infarction.
- To differentiate the mechanisms of pericardial effusion with and without pericardial rub.
Main Methods:
- A cohort of 330 patients with acute Q wave infarction was studied.
- Echocardiography identified pericardial effusion in 83 patients.
- Multivariate analysis assessed clinical variables related to effusion presence with or without pericardial rub.
Main Results:
- Pericardial effusion was detected in 83 of 330 patients.
- Pulmonary capillary wedge pressure and left ventricular asynergy predicted effusion without rub.
- Ventricular aneurysmal motion, left ventricular asynergy, and alveolar-arterial oxygen difference predicted effusion with rub.
Conclusions:
- Hemodynamic factors contribute to hydropericardia in early MI without pericardial rub.
- Increased myocardial microvascular permeability is associated with pericardial effusion and rub in early MI.
- Distinct mechanisms underlie pericardial effusion in early myocardial infarction, influencing clinical presentation.
Abstract:
To elucidate the clinical characteristics associated with pericardial effusion in the early phase of myocardial infarction, 330 patients with acute Q wave infarction were studied. According to echocardiography, 83 patients had pericardial effusion on the third day of hospitalization, and careful auscultation revealed that a pericardial rub was absent in 45 patients and was present in 38 patients. Based on seven clinical variables, multivariate analysis was performed to determine the important variables related to the occurrence of pericardial effusion with and without pericardial rub. Pulmonary capillary wedge pressure and left ventricular segments with advanced asynergy were the significant factors related to the occurrence of pericardial effusion without a pericardial rub. The presence of ventricular aneurysmal motion, left ventricular segments with advanced asynergy, and alveolar arterial oxygen difference were related to pericardial effusion with a pericardial rub. Therefore, a hemodynamic factor was the major mechanism associated with the increase in extravascular myocardial fluid and the consequent occurrence of hydropericardia in the absence of a pericardial rub, whereas an increase in the microvascular permeability in the myocardium with excessive fluid exudating through the irritated epicardial surface was the mechanism related to pericardial effusion with a pericardial rub in the early phase of acute myocardial infarction.