Postpericardiotomy syndrome
Encyclopedia
Postpericardiotomy syndrome (PPS) is a medical syndrome referring to an immune phenomenon that occurs days to months (usually 1–6 weeks) after surgical incision of the pericardium
(membranes encapsulating the human heart). PPS can also be caused after a trauma, a puncture of the cardiac or pleural structures (such as a bullet or stab wound), after percutaneous coronary intervention
(such as stent
placement after a myocardial infarction
or heart attack), or due to pacemaker or pacemaker wire placement.
), pericarditis (with possible pericardial effusion
), occasional but rare pulmonary infiltrates, and fatigue. Cough, pleuritic or retrosternal chest pain, and decreased oxygen saturation can also be seen in some cases.
can be auscultated indicating precarditis. Auscultation of the lungs can show crackles indicating pulmonary infiltration, and there can be retrosternal/pleuritic chest pain worse on inspiration
(breathing in). Patient can also depict sweating and agitation (diaphoresis
) or anxiety.
. Possible cell mediated immunity led by Helper T-cells and Cytotoxic T-cells is postulated to be important in the pathogenesis of this condition. There is also possibility of anti-cardiac antibodies created idiopathically, or due to concurrent cross-reactivity of the antibodies produced against viral antigens, however the latter assumption is not fool-proof or completely reliable due to conflicting studies.
, pericardial effusion, pericardial tamponade
, pleuritis, and pulmonary infiltration. Of these cardiac tamponade is the most life threatening complication. The pericardial fluid increases intra-pericardial pressure therefore preventing complete expansion of the atria and the ventricles upon the diastole. This causes equilibration of the pressure in all four heart chambers, and results in the common findings of the tamponade which are pulsus paradoxus
, Beck's triad of hypotention, muffled heart sounds, and JVD, as well as EKG or Holter monitor findings such as electrical alternans
. Physically the patientes who progress to severe pericardial tamponade obtundate, become mentally altered, and lethargic. If left untreated, severe cardiac output decrease, vascular collapse, and hypoperfusion of body including the brain results in death.
Pericardium
The pericardium is a double-walled sac that contains the heart and the roots of the great vessels.-Layers:...
(membranes encapsulating the human heart). PPS can also be caused after a trauma, a puncture of the cardiac or pleural structures (such as a bullet or stab wound), after percutaneous coronary intervention
Percutaneous coronary intervention
Percutaneous coronary intervention , commonly known as coronary angioplasty or simply angioplasty, is one therapeutic procedure used to treat the stenotic coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build up of cholesterol-laden plaques...
(such as stent
Stent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
placement after a myocardial infarction
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
or heart attack), or due to pacemaker or pacemaker wire placement.
Signs & Symptoms
The typical signs of post-pericartiotomy syndrome include fever, pleuritis (with possible pleural effusionPleural effusion
Pleural effusion is excess fluid that accumulates between the two pleural layers, the fluid-filled space that surrounds the lungs. Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during ventilation.-Pathophysiology:...
), pericarditis (with possible pericardial effusion
Pericardial effusion
Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation will lead to an increased intrapericardial pressure and this can negatively affect heart function...
), occasional but rare pulmonary infiltrates, and fatigue. Cough, pleuritic or retrosternal chest pain, and decreased oxygen saturation can also be seen in some cases.
Physical findings
During medical doctor examination,a pericardial friction rubPericardial friction rub
A pericardial friction rub, also pericardial rub, is an audible medical sign used in the diagnosis of pericarditis. Upon auscultation, this sign is an extra heart sound of to-and-fro character, typically with three components, two systolic and one diastolic. It resembles the sound of squeaky...
can be auscultated indicating precarditis. Auscultation of the lungs can show crackles indicating pulmonary infiltration, and there can be retrosternal/pleuritic chest pain worse on inspiration
Inhalation
Inhalation is the movement of air from the external environment, through the air ways, and into the alveoli....
(breathing in). Patient can also depict sweating and agitation (diaphoresis
Diaphoresis
Diaphoresis is excessive sweating commonly associated with shock and other medical emergency conditions.Diaphoretic is the state of perspiring profusely, or something that has the power to cause increased perspiration....
) or anxiety.
Radiological findings
A chest X-ray might depict pleural effusion, pulmonary infiltration, or pericardial effusion.Pathogenesis (Disease process)
This condition is a febrile illness caused by immune attack of the pleura and the pericardiumPericardium
The pericardium is a double-walled sac that contains the heart and the roots of the great vessels.-Layers:...
. Possible cell mediated immunity led by Helper T-cells and Cytotoxic T-cells is postulated to be important in the pathogenesis of this condition. There is also possibility of anti-cardiac antibodies created idiopathically, or due to concurrent cross-reactivity of the antibodies produced against viral antigens, however the latter assumption is not fool-proof or completely reliable due to conflicting studies.
Epidemiology
Uncommon in children and often common in patients receiving cardiac operations that involves opening the pericardium. CABG surgery is a common culprit.Complications
Complications include pericarditisPericarditis
Pericarditis is an inflammation of the pericardium . A characteristic chest pain is often present.The causes of pericarditis are varied, including viral infections of the pericardium, idiopathic causes, uremic pericarditis, bacterial infections of the precardium Pericarditis is an inflammation of...
, pericardial effusion, pericardial tamponade
Cardiac tamponade
Cardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium ....
, pleuritis, and pulmonary infiltration. Of these cardiac tamponade is the most life threatening complication. The pericardial fluid increases intra-pericardial pressure therefore preventing complete expansion of the atria and the ventricles upon the diastole. This causes equilibration of the pressure in all four heart chambers, and results in the common findings of the tamponade which are pulsus paradoxus
Pulsus paradoxus
In medicine, a pulsus paradoxus , also paradoxic pulse or paradoxical pulse, is defined as an exaggeration of the normal variation during the inspiratory phase of respiration, in which the blood pressure declines as one inhales and increases as one exhales...
, Beck's triad of hypotention, muffled heart sounds, and JVD, as well as EKG or Holter monitor findings such as electrical alternans
Electrical alternans
Electrical alternans is an electrocardiographic phenomenon of alternation of QRS complex amplitude or axis between beats and a possible wandering base-line...
. Physically the patientes who progress to severe pericardial tamponade obtundate, become mentally altered, and lethargic. If left untreated, severe cardiac output decrease, vascular collapse, and hypoperfusion of body including the brain results in death.