Treatment of myocardial infarction associated pericarditis

Hi everyone! There are two types of myocardial infarction associated with pericarditis. Let

s learn more about the management!

Early infarct-associated pericarditis: Occurs 1 to 3 days after transmural myocardial infarction (because of the interaction of the healing necrotic epicardium with the overlying pericardium). 

Late post-myocardial infarction pericarditis (Dressler’s syndrome): Occurs weeks to months after myocardial infarction. 

Initial therapy includes high-dose aspirin (650 to 1,000 mg every 6 to 8 hours).

Proton pump inhibitor (PPI)  - improves the gastric tolerability of the aspirin. 

Acetominophen can be added for pain management.

Dosing of aspirin:

Initial: 650 mg to 1 g every 8 hours until resolution of symptoms for at least 24 hours and normalization of inflammatory biomarkers (eg, C-reactive protein). A treatment period of one to two weeks before tapering is usually sufficient. 

Taper: Decrease each dose by 250 to 500 mg every 1 to 2 weeks. Ensure patient remains asymptomatic and inflammatory biomarkers are normal. 

There is no published experience on the use of colchicine in peri-infarction pericarditis. Colchicine may reduce the need for pericardiocentesis or other pericardial interventions and is usually given at a dose of 0.6 mg twice daily for a month, or longer if the patient has a recurrence of symptoms.

Why are NSAIDs such as ibuprofen avoided in the peri-infarct period?

Interferes with the antiplatelet aggregation effects of aspirin. 

Interferes with myocardial healing.

PS: Acetominophen does not affect the coagulation system and can be used.

References:

Post-cardiac injury syndrome: aetiology, diagnosis, and treatment https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

Pericardial Disease https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514

-IkaN (Nakeya Dewaswala)