Post-myocardial infarction syndrome
Evidence: Immune-mediated
Names
Post-pericardiotomy syndrome
Post-cardiac injury syndrome
Dressler’s syndrome
Post-myocardial infarction syndrome
Description
All of the conditions listed here occur following a heart attack, traumatic injury to the heart or the pericardium, or an operation such as coronary artery bypass grafting (CABG), mitral valve replacement, aortic valve replacement, and pacemaker or stent implantation.
They are marked by inflammation of the pericardium (the sac that surrounds the heart) accompanied by high fever. Symptoms occur usually from 3-4 days up to 2-6 weeks post-surgery/injury and on rare occasions symptoms may develop up to a few months post-surgery/injury. Most patients improve with medication and do not suffer chronic illness.
To date, there is no direct or indirect evidence that post-pericardiotomy syndrome is autoimmune. Kaya et al 2012 provides an excellent review of the science of this entire class of disease. However, it states that “…precise mechanisms on how these autoantibodies perpetuate or even induce an organ specific autoimmune response are not yet fully understood.”
Evidence: Circumstantial
Patient Groups
None found.
Bloggers
None found.
Prevalence
US incidence: 89,000. Miller 1988 estimates 17.8% of patients undergoing heart surgery suffer an autoinflammatory/autoimmune response. About 500,000 open-heart surgeries are performed in the US each year, on which we computed the estimate of 89,00. However, since these diseases can be caused by injury unrelated to surgery (a heart attack produces injury that can lead to post-myocardial infarction syndrome without surgery) this estimate is likely to be lower than the actual number.
Typical Age of onset
Any age following a major heart and thoracic surgery. Very rare for patients younger than 2-years-of age. Sources: NIH-Dressler Syndrome Medline Infant Study
Symptoms
Fever
Chest Pain
Shortness of breath
Tachycardia (fast heart rate)
Palpitations
Arrhythmias
Malaise/Weakness/Fatigue
Decreased appetite
Irritability
Joint Pain
Patients undergoing a major heart and thoracic surgery have higher chances of developing Postpericardiotomy Syndrome and Dressler Syndrome if they have the following risk factors:
Young age
Prior history of Pericarditis
B-negative blood type
