Postinfarktperikardit

Postinfarktperikardit is inflammation of the pericardium that develops after a myocardial infarction. It most commonly follows transmural infarction. The condition is typically categorized into an early form and a late form. Early postinfarktperikardit usually occurs within the first days after the MI, whereas the late form, often referred to as Dressler syndrome, appears weeks to months later and is thought to be autoimmune in origin.

Clinical features include pleuritic chest pain that worsens with inspiration and improves when sitting up, a pericardial friction rub, and fever. If a significant pericardial effusion develops, shortness of breath may occur. Diagnosis relies on the clinical picture supported by electrocardiography, imaging, and inflammatory markers. ECG can show diffuse ST-segment elevations and PR-segment depressions in some cases, while echocardiography assesses for pericardial effusion. Laboratory tests may reveal elevated inflammatory markers such as C-reactive protein and leukocytosis.

Management aims to relieve inflammation while preserving myocardial healing after MI. For early postinfarction pericarditis, aspirin is generally preferred to other nonsteroidal anti-inflammatory drugs due to concerns about healing; colchicine may be added in selected patients. For Dressler syndrome and other late postinfarction pericarditis, nonsteroidal anti-inflammatory drugs (preferably aspirin) and colchicine are commonly used; corticosteroids are reserved for refractory cases because they can increase recurrence or impede healing. Pericardiocentesis may be necessary if a large effusion causes tamponade or hemodynamic compromise.

Prognosis is typically favorable with appropriate treatment, though recurrence can occur.