Pericarditits After A Heart Attack

The lining or sac that surrounds the heart is called the pericardium. A heart attack that injures the entire thickness of the heart can sometimes irritate and inflame the heart sac (pericardium).

Symptoms usually appear a few hours to a week after a heart attack, although in some cases, they may be delayed several weeks or even months. The most common symptom is chest pain, often mild, sometimes only occurring when the person is asked to inhale deeply. Others may have pain when they move or change body positions.

Joint pains and mild fever may also occur. With a stethoscope, the healthcare provider can sometimes hear a sound called a friction rub when this condition occurs. This scratchy sound (described as similar to that of someone sitting in a new saddle on mounting a horse) is made when the surface of the heart and the inflamed heart lining rub together.

This condition is a result of a heart attack and is more likely to follow a large than a small one. Other causes of pericarditis include a bacterial infection, which causes bacterial pericarditis, and adhesions, which cause constrictive pericarditis.

There are no known ways to prevent this condition after a heart attack. A person with known heart disease should be seen by the healthcare provider regularly to reduce the risk of a heart attack.

Diagnosis starts with a history and physical exam. This is often enough to make the diagnosis, especially when the friction rub sound is present. An ECG (heart tracing) aids in the diagnosis and help make sure the person is not having another heart attack.

Blood tests, including tests called a complete blood count, or CBC, and erythrocyte sedimentation rate, can also yield useful information.

An imaging test, called an echocardiogram, uses ultrasound waves to see the heart and may also help make the diagnosis in some cases.

In most cases, this condition causes few or no long-term effects. In some people, this condition may come back several times with severe pain, but it usually responds to treatment each time.

There are no risks to others.

Pericarditis after a heart attack usually responds to a short course of aspirin, or other anti-inflammatory drugs called NSAIDs. Stronger pain medications, such as the narcotic morphine, are given if needed. In severe or repeat cases, corticosteroid medications such as prednisone may be given.

Aspirin and NSAIDs may cause allergic reactions, stomach upset, or kidney damage. Narcotics can cause constipation, stomach upset, and allergic reactions. Corticosteroids can cause weakening of the muscle in the area of the heart attack, weight gain, depression, and other side effects.

Most episodes of pericarditis after a heart attack resolve by themselves and need no further treatment. The focus is usually on treating the underlying heart disease. In some cases, treatment may be needed in the future for repeated episodes of pericarditis.

If the symptoms go away, the only needed monitoring is for the underlying heart disease. Someone who has had one heart attack needs close monitoring and treatment to prevent a second one. Any new or worsening symptoms should be reported to the healthcare provider.