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]
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC