Post-Pericardotomy Syndrome

OVERVIEW

  • Post-Pericardotomy Syndrome = febrile illness secondary to an inflammatory reaction involving the pleura + pericardium.
  • development of anti-heart antibiodies (autoimmune) + viral (coxasackie B, adenovirus, CMV)
  • incidence = 21% post pericardotomy

HISTORY

  • mild, self-limiting inflammatory illness
  • 1-6 weeks post surgery
  • pericardial pain
  • pleuritic pain
  • vomiting (in children prior to tamponade)
  • can progress to tamponade -> cardiovascular collapse

RISK FACTORS

  • recent pericardotomy
  • post MI (Dresslers syndrome)
  • coronary stent
  • epicardial pacemaker leads
  • tranvenous pacemaker leds
  • blunt trauma
  • stab wounds
  • heart puncture

EXAMINATION

  • fever (38-40 C)
  • pericardial rub
  • pleural effusion
  • pneumonitis

INVESTIGATIONS

  • leukocytosis with left shift
  • elevated inflammatory markers
  • elevated anti-heart antibodies (usually high)
  • ECG: widespread ST elevation and TWI
  • CXR: pericardial effusion + pleural effusions
  • ECHO: small amount of pericardial effusion -> tamponade

MANAGEMENT

  • tamponade -> decompression
  • pericardial window
  • aspirin/NSAIDS
  • prednisone
  • colchricine 1mg BD on first day -> 0.5mg BD for 1 month (primary prevention – shown to decrease incidence from 21% to 9% -> statistically significant difference)

References and Links

  • COPPS Investigators. COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS): a multicentre, randomized, double-blind, placebo-controlled trial. Eur Heart J. 2010 Nov;31(22):2749-54 [PMID 20805112]

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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