Postoperative Endocarditis - Causes, Symptoms, Diagnosis, and Treatment

What Is Postoperative Pericarditis?

Postoperative pericarditis is the immune reaction following surgery for days to months (typically one to six weeks). This condition can likewise be caused after an injury or puncture of the pleural membrane (for example, a stab injury), after percutaneous coronary surgery (for example, stent position after myocardial localized necrosis or respiratory failure), or because of a pacemaker or pacemaker wire placement. This condition may also be known as Dressler's syndrome. This condition may be caused due to inflammation of the outer layer of the heart. This happens when our immune system may react to damage to the heart. The inflammation of the outer layer of the heart can cause it to swell. This swelling may exert pressure on the nerves, which may, in turn, lead to chest pain-like conditions. This condition may also be known as a post-pericardiotomy syndrome.

Who Can Be Affected by Postoperative Pericarditis?

This condition can occur to anyone. It has no racial or sex predilection. However, it is most commonly seen in people between the age of 20 to 50 years. The risk factors of Dressler's syndrome are:

1. Heart surgery

2. Heart attack.

3. Any procedure of the heart, such as placement of a stent.

4. Any injury to the heart or its muscles due to an accident.

5. Viral infection of the heart.

6. A previous history of pericarditis.

How Common Is Postoperative Pericarditis?

This condition is very rare owing to superior medical practices. It may, however, occur in 0.1 % of surgeries. This may also be associated with a previous history of pericarditis.

What May Be the Symptoms of Postoperative Pericarditis?

The various symptoms of postoperative pericarditis may include the following:

1. Fatigue: The patient may experience extreme fatigue. They may not be able to perform day-to-day activities.

2. Fever: The patient may present with a persistent low-grade fever.

3. Chest Pain: The patient may present with chest pain. This could be persistent or can be intermittent. The pain may worsen with activity. It may increase while lying down. The patient also complains of pain in the arms and shoulders.

4. Weakness: The patient can show symptoms of extreme weakness.

5. Difficulty in Breathing: The patient may complain of difficulty in breathing. This may increase while doing some work or while lying down.

6. Loss of Appetite: The patient may complain of loss of appetite.

Can Postoperative Pericarditis Be Fatal?

Postoperative pericarditis may not be life-threatening. But medical attention should be obtained earliest if discomfort arises a few weeks after surgery.

What Causes Postoperative Pericarditis?

The exact cause of this condition is unclear. It is the immune system’s reaction to injury and damage to the heart. The other causes of Dressler’s syndrome may include:

1. Heart attack.

2. Any invasive procedures such as placement of pacemakers or other cardiac devices.

3. Any injury or trauma to the chest.

How Can Postoperative Pericarditis Be Diagnosed?

The various tests that can be performed to diagnose postoperative pericarditis may include the following:

1. Physical Examination: The doctor will perform a physical examination and check for pain, fever, and other symptoms.

2. Patient History: The doctor may ask for the patient's medical history. The doctor may ask for any history of heart attack, heart surgery, or injury.

3. Blood Test: A complete blood checkup can be done to rule out other pathologies. The elevation of C-reactive protein in the blood can indicate a heart attack. An elevated ESR (erythrocyte sedimentation rate) can indicate an infection.

4. Electrocardiogram (ECG): An ECG can be performed to check for any variations or abnormalities in the heart rhythm.

5. X-ray: The doctor may perform an X-ray to check for any changes in the size of the heart or any fluid build-up.

6. Echocardiogram: This test can identify the presence of fluid around the heart (in the pericardium, the coating around the heart muscle), how much liquid, if any, and any potential effect this liquid might have on the heart muscle.

7. CT(Computed Tomography) Scan or MRI (Magnetic Resonance Imaging) Scan: These imaging tests might be more valuable in follow-up to check for the thickening or abundance of fluid in the pericardium or pressure of the heart from the thickened pericardium.

How Can Postoperative Pericarditis Be Treated?

Treatment is pointed toward diminishing the aggravation of the condition. The physician could recommend taking over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen, Naproxen, or other anti-inflammatory medicines. The medicines can be given for about four to six months. Other anti-inflammatory medicines, such as Colchicine, may also be prescribed. If the OTC drugs do not work on the side effects, the physician could recommend corticosteroids, which may be helpful in reducing inflammation. As a result of their incidental effects, corticosteroids are generally as a final option.

Is Surgery an Option for Postoperative Pericarditis?

In some cases of severe pericarditis, the doctor may perform a surgery called pericardiocentesis. They will utilize a needle to empty liquid out of the pericardium. The patient will have a catheter that channels liquid for a little while, and the patient will also continue to take medication.

What Can Be the Side Effects of Postoperative Endocarditis?

Postoperative pericarditis can increase the risk of pericardiocentesis. There is a chance of 4 % to 20 % for complications of postoperative pericarditis.

The complications of postoperative pericarditis include:

1. Damage to other organs.

2. Arrhythmia or irregular heartbeat.

3. Cardiac arrest.

4. Collapsed lung.

5. Internal bleeding.

What Are the Complications of Postoperative Pericarditis?

The complications of postoperative pericarditis can be life-threatening. Hence it is necessary to obtain medical attention as the earliest. The complications of this condition may include:

1. Cardiac Tamponade: Overabundance of liquid develops in the pericardium, which then comes down to the heart. Serious pressure on the heart obstructs its capacity to work. This can cause the blood pressure to drop. This issue can be lethal without treatment.

2. Constructive Pericarditis: Solidifying, as well as thickening of the pericardium causes, weakened heart capability. The heart might become packed, making blood back into the lungs.

How Long Can This Condition Persist?

With appropriate treatment, this condition resolves in four to six weeks.

Conclusion:

Postoperative pericarditis can be a very rare condition. It may occur after surgery or injury. Once the symptoms arise, medical attention should be obtained at the earliest.