postcardiotomy syndrome
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Etiology
- pericardiotomy
- coronary stent implantation
- implantation of epicardial pacemaker leads
- blunt trauma
- stab wounds
- heart puncture
Pathology
- autoimmune response against damaged cardiac tissue (putative)
- inflammatory reaction involving the pleura & pericardium
Clinical manifestations
- occurs 2 weeks to 1 year after pericardiotomy
- fever, pleuritis, pericarditis, or arthritis, together with petechiae on the skin & palate
Laboratory
- complete blood count (CBC)
- leukocytosis with left shift
- blood cultures negative
- acute phase reactants ESR & serum CRP are elevated
- pericardial fluid analysis (if pericardial drain placed)
- cell count, differential, cytology, culture, gram stain, triglyceride level, total protein level[2]
Differential diagnosis
- Dressler's syndrome
- ref[2] describes Dressler's syndrome as a subtype of postcardiotomy syndrome
- myocarditis
- pericarditis
- endocarditis
Management
- nonsteroidal anti-inflammatory agents (NSAIDs)
- glucocorticoids (Prednisone)
- case reports of successful use of
- single high dose of intravenous immunoglobulin
- low weekly dose of methotrexate
More general terms
References
- ↑ Wikipedia: Postcardiotomy syndrome http://en.wikipedia.org/wiki/Postcardiotomy_syndrome
- ↑ 2.0 2.1 2.2 Horenstein MS and Berger S Medscape: eMedicine: Postpericardiotomy Syndrome http://emedicine.medscape.com/article/891471-overview