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Peri-Infarction Pericarditis, Rare Complication of Myocardial Infarction

Author : S.A. Hutomo, Andrianto
Upload Date : 19-04-2018

Background: Myocardial infarction could lead to various complications, including pericardial complications. Acute pericarditis is one of pericardial complication which are rare in reperfusion era. Nevertheless, the pericardial complication could alter the management of patient with myocardial infarction

Case: A male, 58 y.o, came to ER with acute typical chest pain, since 3 days ago, worsening in last 3 hours. The risk factors was heavy smoker and diabetes. Physical examination reflects circulatory shock (hypotension, tachycardia, low urine production). No ronchi. ECG shows sinus tachycardia rhythm 140 bpm, with pathologic Q waves and ST elevation at V2-V5, I-aVL leads. Troponin was high (13.1) indicating a recent infarction. The patient was not going to PCI because of financial issue. And then echocardiography was performed. Echocardiography shows hypokinetic in anterior, antero-septal and anterolateral segments. EF was 45% (biplane) It also shows pericarditis sign, moderate pericardial effusion at basal, inferior causing right atrial collapse. The acute treatment was oxygenation, administration of intravenous fluid bolus (1000 ml NaCl 0.9%) with close monitoring, dobutamine injection, aspirin 750 mg q8h. The patient was stabilized in first 24 hours.

Discussion: Pericarditis could happen in myocardial infarction setting. MI lead the inflammatory reaction that trigger the fluid production in pericardium. The clinical diagnosis of pericarditis in MI setting could be difficult, since the symptoms and ECG were similar. Echocardiography was the key of diagnosis, since it can detect the pericardial effusion, LV function, and hemodynamic status. Acute pericardial effusion may increase intrapericardial pressure rapidly that leads reduction of cardiac filling. It could aggravate hemodynamic status, which already compromised caused by extensive anterior infarct. Thus, the resuscitation strategy must be individually tailored with hemodynamic status of the patient.

Conclusion: We reported patient with acute pericarditis due to myocardial infarction, complicating a pericardial effusion leads to circulatory shock. Echocardiography is a key diagnostic tool to guide the diagnosis and emergency management of patient

KEYWORDS : acute pericarditis, myocardial infarction, shock


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