Postcardiotomy syndrome - Clinicals, Diagnosis, and Management

Cardiovascular

Clinicals - History

Fact Explanation
A predisposing conditon Postcardiotomy/pericardiotomy syndrome is a condition which, in some patients, follows a traumatic incident which results in opening of the pericardium. It is an uncommon complication of cardiac surgeries, myocardial infarction, blunt or penetrating chest trauma or procedures involving pericardiotomy. The underlying pathology is development of an immune reaction the cardiac or pericardial tissue due to development of anti-heart antibodies. Presence of microbiological agents also have been studied. The average time for onset of symptoms following a predisposing condition is around 20 days. A predisposing conditon
Postcardiotomy/pericardiotomy syndrome is a condition which, in some patients, follows a traumatic incident which results in opening of the pericardium. It is an uncommon complication of cardiac surgeries, myocardial infarction, blunt or penetrating chest trauma or procedures involving pericardiotomy. The underlying pathology is development of an immune reaction the cardiac or pericardial tissue due to development of anti-heart antibodies. Presence of microbiological agents also have been studied. The average time for onset of symptoms following a predisposing condition is around 20 days.
Fever Due to the inflammatory reaction. Fever
Due to the inflammatory reaction.
Chest pain Chest pain with relation to the inspiration phase of respiration is an important indicative factor of pericardial effusion. The pain can be exertional, radiated to abdomen, shoulders or back of the chest. Chest pain
Chest pain with relation to the inspiration phase of respiration is an important indicative factor of pericardial effusion. The pain can be exertional, radiated to abdomen, shoulders or back of the chest.
Difficulty in breathing Due to pleural effusion, it was present in more than half of the patients in one study. Difficulty in breathing
Due to pleural effusion, it was present in more than half of the patients in one study.
Arthalrgia Due to autoimmune arthopathy. Arthalrgia
Due to autoimmune arthopathy.

Clinicals - Examination

Fact Explanation
Fever Due to the inflammatory reaction. Fever
Due to the inflammatory reaction.
Pericardial friction rub Due to autoimmune inflammation of the pericardium. Pericardial friction rub
Due to autoimmune inflammation of the pericardium.
Ascites Systemic fluid collections are also common findings. Ascites
Systemic fluid collections are also common findings.

Investigations - Diagnosis

Fact Explanation
Complete blood count Leucocytosis is the expected finding. Complete blood count
Leucocytosis is the expected finding.
Erythrocyte sedimentation rate Increased due to inflammatory reaction. Erythrocyte sedimentation rate
Increased due to inflammatory reaction.
Anti-heart antibodies Auto-antibodies are positive since it is an autoimmune condition. Anti-heart antibodies
Auto-antibodies are positive since it is an autoimmune condition.
Chest X-ray To look for evidence of pericardial and/ or pleural effusion. Chest X-ray
To look for evidence of pericardial and/ or pleural effusion.
Echocardiography It is the diagnostic test. Echocardiography
It is the diagnostic test.
12 lead electrocardiogram Might mimic pericarditis initially. 12 lead electrocardiogram
Might mimic pericarditis initially.

Management - Supportive

Fact Explanation
Patient education Education of the patient regarding the diagnosis, and the good prognosis of the condition even though there can be progressive nature and recurrences. Patient education
Education of the patient regarding the diagnosis, and the good prognosis of the condition even though there can be progressive nature and recurrences.

Management - Specific

Fact Explanation
Non-steroidal anti-inflammatory drugs Oral non steroidal anti inflammatory drugs usually receive a good response in milder cases. i.e. Aspirin. The dose can be reduced with the response. Non-steroidal anti-inflammatory drugs
Oral non steroidal anti inflammatory drugs usually receive a good response in milder cases. i.e. Aspirin. The dose can be reduced with the response.
Corticosteroids Given for a short course of high dose and then tapered off. Corticosteroids
Given for a short course of high dose and then tapered off.
Intravenous immunoglobulin Given in single high dose has the best outcome. Intravenous immunoglobulin
Given in single high dose has the best outcome.
Pericardiocentesis In severe cases of pericardial effusions. Sometimes it can be life-saving. The pericardial fluid should be sent for analysis including microbiological studies. Pericardiocentesis
In severe cases of pericardial effusions. Sometimes it can be life-saving. The pericardial fluid should be sent for analysis including microbiological studies.

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