Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2009 Feb 3;20(4):327–331. doi: 10.1002/clc.4960200405

Pericardial involvement in acute myocardial infarction in the post‐thrombolytic era: Clinical meaning and value

Ernesto Correale 1,✉, Salvatore Romano 1, Vincenzo Ricciardiello 1, Rossano Battista 1, Aldo P Maggioni 2, Eugenio Santoro 2
PMCID: PMC6656061  PMID: 9098589

Abstract

Pericardial involvement (PI) in acute myocardial infarction (AMI) is a complication usually considered benign and has therefore received less attention than those more severe. It may be easily missed because it presents few symptoms and signs, which in turn may be confused with those of AMI. Its path physiology, diagnosis, and pitfalls are discussed. The GISSI‐1 trial revealed a marked reduction of PI in the group treated with thrombolysis. This unexpected finding was later confirmed by the GISSI‐2 trial and by other studies, drawing attention to its meaning. Data from the GISSI as well as from other studies have been reviewed and seem to indicate that PI is associated with larger AMIs and with a significant increase in 6‐ and 12‐month mortality. This may be attributed to the consequences of late remodeling of a large infarction. These findings lead to the conclusion that PI should be granted more attention, and that it might identify patients with a poorer long‐term outcome.

Keywords: pericarditis, acute myocardial infarction, site of infarction

Full Text

The Full Text of this article is available as a PDF (574.4 KB).

References

  • 1. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI) : Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; 1: 394–407. [PubMed] [Google Scholar]
  • 2. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico Acuto GISSI‐2 : A factorial randomized trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet 1990; 336: 65–71. [PubMed] [Google Scholar]
  • 3. Volpi A, Maggioni AP, Franzosi MG, Pampallona S, Mauri F, Tognoni G: In‐hospital prognosis of patients with acute myocardial infarction complicated by primary ventricular fibrillation. N Engl J Med 1987; 317: 257–261. [DOI] [PubMed] [Google Scholar]
  • 4. Maggioni AP, Franzosi MG, Santoro E, White H, Van de Werf F, Tognoni G, and the GISSI‐2 and the International Study Group : The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. N Engl J Med 1992; 327: 1–6. [DOI] [PubMed] [Google Scholar]
  • 5. Correale E, Maggioni AP, Romano S, Ricciardiello V, Battista R, Salvarola G, Santoro E, Tognoni G: Comparison of frequency, diagnostic and prognostic significance of pericardial involvement in acute myocardial infarction treated with and without thrombolytics. Am J Cardiol 1993; 71: 1377–1381. [DOI] [PubMed] [Google Scholar]
  • 6. Van de Werf F, Arnold AER, for The European Cooperative Study Group for recombinent tissue type plasminogen activator : Intravenous plasminogen activator and size of infarct, left ventricular function and survival in acute myocardial infarction. Br Med J 1988; 297: 1374–1379. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Roberts WC, Ferrans VJ: A survey of the causes and consequences of pericardial heart disease In Pericardial Disease (Eds. Reddy PS, Leon DL, Shaver JA), p. 49 New York: Raven Press, 1982. [Google Scholar]
  • 8. Ley K: Molecular mechanisms of leucocyte rolling and adhesion to microvascular endothelium. Eur Heart J 1993; 14 (suppl I): 68–73. [PubMed] [Google Scholar]
  • 9. Wartman SB, Hallerstein HK: The incidence of heart disease in 2000 consecutive autopsies. Ann Intern Med 1948; 28: 41–49. [DOI] [PubMed] [Google Scholar]
  • 10. Ehrenhaft JL, Taber RE: Hemopericardium and constrictive pericarditis. J Thorac Surg 1952; 24: 255–261. [PubMed] [Google Scholar]
  • 11. Willerson JT, Watson JJ, Hutton I, Templeton GH, Fixter DE: Reduced myocardial reflow and increased coronary vascular resistance following prolonged myocardial ischemia in the dog. Circ Res 1975; 36: 771–781. [DOI] [PubMed] [Google Scholar]
  • 12. Krainin FM, Flessas AP, Spodick DH: Infarction associated pericarditis. Rarity of diagnostic electrocardiogram. N Engl J Med 1984; 311: 1211–1214. [DOI] [PubMed] [Google Scholar]
  • 13. Blumer G: Pericarditis epistenocardica. J Am Med Assoc 1936; 107: 178–184. [Google Scholar]
  • 14. Thadani U, Chopra MP, Aber COP, Portal RW: Pericarditis after acute myocardial infarction. Br Med J 1971; 2; 135–137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Galve E, Garcia Del Casillo H, Evangelista A, Battle J, Permanyer Miralda G, Soler‐Soler J: Pericardial effusion in the course of myocardial infarction: Incidence, natural history and clinical relevance. Circulation 1986; 73: 294–299. [DOI] [PubMed] [Google Scholar]
  • 16. Sugiura T, Iwasaka T, Takehana T, Takohava K, Nagahama K, Taniguchi H, Ianda M: Clinical significance of pericardial effusion association with pericarditis in acute Q wave anterior myocardial infarction. Chest 1993; 104 (2): 412–418. [DOI] [PubMed] [Google Scholar]
  • 17. Oliva PB, Hammill SC, Edwards WO: Electrocardiographic diagnosis of postinfarction regional pericarditis. Ancillary observations regarding the effect of reperfusion on the rapidity and amplitude of T wave inversion after acute myocardial infarction. Circulation 1993; 88 (3): 896–904. [DOI] [PubMed] [Google Scholar]
  • 18. Oliva PB, Hammill SC, Edwards WD: The electrocardiographic diagnosis of regional pericarditis in acute myocardial infarction. Eur Heart J 1993; 14 (12): 1683–1691. [DOI] [PubMed] [Google Scholar]
  • 19. Oliva PB, Hammill SC, Talano JV: Effect of definition on incidence of postinfarction pericarditis. Is it time to redefine postinfarction pericarditis? Circulation 1994; 90 (3): 1537–1541. [DOI] [PubMed] [Google Scholar]
  • 20. Oliva PB, Hammill SC: The clinical distinction between regional postinfarction pericarditis and other causes of post infarction chest pain: Ancillary observations regarding the effect of lytic therapy upon the frequency of postinfarction pericarditis, postinfarction angina, and reinfarction. Clin Cardiol 1994; 17 (9): 471–478. [DOI] [PubMed] [Google Scholar]
  • 21. Oliva PB, Hammill SC, Talano JV: T changes consistent with epicardial involvement in acute myocardial infarction. Observations in patients with a postinfarction pericardial effusion without clinically recognized postinfarction pericarditis. J Am Coll Cardiol 1994; 24 (4): 1073–1077. [DOI] [PubMed] [Google Scholar]
  • 22. Lichstein E, Liu HM, Gupta P: Pericarditis complicating acute myocardial infarction: Incidence of complications and significance of electrocardiogram on admission. Am Heart J 1974; 87: 246–252. [DOI] [PubMed] [Google Scholar]
  • 23. Guillevin L, Valere PE: Infarction associated pericarditis. N Engl J Med 1985; 312: 534. [DOI] [PubMed] [Google Scholar]
  • 24. Tofler GH, Muller JE, Stone PH, Wellich SN, Davik VG, Poole WK, Robertson T, Braunwald E: Pericarditis in acute myocardial infarcation: Characterization and clinical significance. Am Heart J 1989; 117 (1): 86–92. [DOI] [PubMed] [Google Scholar]
  • 25. Glick S: Infarction associated pericarditis. N Engl J Med 1985; 584 (letter). [DOI] [PubMed] [Google Scholar]
  • 26. Spodick DH: Frequency of arrhythmias in acute pericarditis determined by Holter monitoring. Am J Cardiol 1984; 53: 842–845. [DOI] [PubMed] [Google Scholar]
  • 27. Diamond T: The ST segment axis: A distinguishing feature between acute pericarditis and acute myocardial infarction. Heart Lung 1985; 14 (6): 629–631. [PubMed] [Google Scholar]
  • 28. Burma GM, Emerman CL: Pericarditis mimicking acute myocardial infarction. Am J Emerg Med 1986; 4 (3): 262–264. [DOI] [PubMed] [Google Scholar]
  • 29. Kubota T, Imaizumi T, Chishaki A, Hayashi Y, Inou T, Takeshita A: Acute myocardial infarction with a hemodynamic pattern resembling constrictive pericarditis. Jpn Heart J 1991; 32 (4): 515–520. [DOI] [PubMed] [Google Scholar]
  • 30. Khandheria BK, Shub C, Nishimura RA, Miller FA Jr, Seward JB, Tajik AJ: To anticoagulate or not: Implications for management of patients with acute myocardial infarction complicated by both left ventricular thrombus and pericardial effusion. Can J Cardiol 1987; 3 (4): 173–176. [PubMed] [Google Scholar]
  • 31. Beahrs MM, Dietzman RH, Edwards JE: Pericardial effusion complicating acute myocardial infarction. Minnesota Med 1989; 72 (1): 33–37. [PubMed] [Google Scholar]
  • 32. Gregoratos G: Pericardial involvement in acute myocardial infarction. Cardiol Clin 1990; 8 (4): 601–608. [PubMed] [Google Scholar]
  • 33. Wall TC, Califf RM, Harrelson‐Woodlief L, Mark DB, Honan M, Abbotmath CW, Candela R, Berrios E, Philips HR, Topol EJ, and the TAMI Study Group : Usefulness of a pericardial friction rub after thrombolytic therapy during acute myocardial infarction in predicting amount of myocardial damage. Am J Cardiol 1990; 66: 1418–1421. [DOI] [PubMed] [Google Scholar]
  • 34. Reimer KA, Lowe JE, Rassmussen MM, Jennings RB: The wave front phenomenon of ischemic cell death. Myocardial infarct size vs. duration of coronary occlusion in dogs. Circulation 1977; 56: 786–794. [DOI] [PubMed] [Google Scholar]
  • 35. Erhardt LR: Clinical and pathological observation in different types of acute myocardial infarction: A study of 84 patients deceased after treatment in a coronary care unit. Acta Med Scand (suppl) 1974; 560: 1–78. [PubMed] [Google Scholar]
  • 36. Levine HD: Subendocardial infarction in retrospect: Pathologic, cardiographic and ancillary features. Circulation 1985; 72: 790–800. [DOI] [PubMed] [Google Scholar]
  • 37. Millaire A, de Groote P, Decoulx E, Leroy O, Douloux G: Outcome after thrombolytic therapy of nine cases of myoperiearditis misdiagnosed as myocardial infarction. Eur Heart J 1995; 16 (3): 333–338. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES