Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Pericardial complications of myocardial infarction

Martin M LeWinter, MD
Section Editors
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Jae K Oh, MD
Deputy Editor
Brian C Downey, MD, FACC


Following a myocardial infarction (MI), patients are at risk for a variety of cardiac complications. Many complications are mechanical (eg, papillary muscle rupture or left ventricular wall rupture, ventricular septal defect) and are related to the extent of myocardial injury, while other post-MI complications are immunologic, inflammatory, or iatrogenic.

Three major types of pericardial complications can occur in patients following a myocardial infarction:

Early infarct-associated pericarditis (often termed peri-infarction pericarditis)

Pericardial effusion (with or without tamponade), including hemopericardium (due to myocardial rupture)

Postcardiac injury (Dressler's) syndrome

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: Dec 21, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Correale E, Maggioni AP, Romano S, et al. Comparison of frequency, diagnostic and prognostic significance of pericardial involvement in acute myocardial infarction treated with and without thrombolytics. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI). Am J Cardiol 1993; 71:1377.
  2. Wall TC, Califf RM, Harrelson-Woodlief L, et al. Usefulness of a pericardial friction rub after thrombolytic therapy during acute myocardial infarction in predicting amount of myocardial damage. The TAMI Study Group. Am J Cardiol 1990; 66:1418.
  3. Shahar A, Hod H, Barabash GM, et al. Disappearance of a syndrome: Dressler's syndrome in the era of thrombolysis. Cardiology 1994; 85:255.
  4. Tofler GH, Muller JE, Stone PH, et al. Pericarditis in acute myocardial infarction: characterization and clinical significance. Am Heart J 1989; 117:86.
  5. Oliva PB, Hammill SC, Edwards WD. 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; 88:896.
  6. Oliva PB, Hammill SC, Talano JV. T wave 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; 24:1073.
  7. Figueras J, Juncal A, Carballo J, et al. Nature and progression of pericardial effusion in patients with a first myocardial infarction: relationship to age and free wall rupture. Am Heart J 2002; 144:251.
  8. Figueras J, Barrabés JA, Serra V, et al. Hospital outcome of moderate to severe pericardial effusion complicating ST-elevation acute myocardial infarction. Circulation 2010; 122:1902.
  9. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:e362.
  10. Hammerman H, Alker KJ, Schoen FJ, Kloner RA. Morphologic and functional effects of piroxicam on myocardial scar formation after coronary occlusion in dogs. Am J Cardiol 1984; 53:604.
  11. Silverman HS, Pfeifer MP. Relation between use of anti-inflammatory agents and left ventricular free wall rupture during acute myocardial infarction. Am J Cardiol 1987; 59:363.
  12. Roberts R, DeMello V, Sobel BE. Deleterious effects of methylprednisolone in patients with myocardial infarction. Circulation 1976; 53:I204.
  13. Stubbs DF. Post-acute myocardial infarction symptomatic pericarditis (PAMISP): report on a large series and the effect of methylprednisolone therapy. J Int Med Res 1986; 14 Suppl 1:25.
  14. Galve E, Garcia-Del-Castillo H, Evangelista A, et al. Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance. Circulation 1986; 73:294.
  15. Sugiura T, Iwasaka T, Takayama Y, et al. Factors associated with pericardial effusion in acute Q wave myocardial infarction. Circulation 1990; 81:477.
  16. Sugiura T, Iwasaka T, Tarumi N, et al. Clinical significance of pericardial effusion in Q-wave inferior wall acute myocardial infarction. Am J Cardiol 1994; 73:862.
  17. Sugiura T, Iwasaka T, Takehana K, et al. Clinical significance of pericardial effusion associated with pericarditis in acute Q-wave anterior myocardial infarction. Chest 1993; 104:415.
  18. Widimský P, Gregor P. Pericardial involvement during the course of myocardial infarction. A long-term clinical and echocardiographic study. Chest 1995; 108:89.
  19. Belkin RN, Mark DB, Aronson L, et al. Pericardial effusion after intravenous recombinant tissue-type plasminogen activator for acute myocardial infarction. Am J Cardiol 1991; 67:496.
  20. Patel MR, Meine TJ, Lindblad L, et al. Cardiac tamponade in the fibrinolytic era: analysis of >100,000 patients with ST-segment elevation myocardial infarction. Am Heart J 2006; 151:316.
  21. Beck, CS . Two cardiac compression triads. J Am Med Assoc 1935; 104:714.