Postpericardial Injury Syndrome: An Autoimmune Phenomenon

Abstract

Postpericardial injury syndrome (PPIS) is defined as pericarditis or pericardial effusion that results from recent or earlier injury of the pericardium. The clinical features of this syndrome include fever, leukocytosis, and elevated erythrocyte sedimentation rate. Recent studies have established a connection between this clinical presentation and an underlying autoimmune process. The role of the humoral immune response is well established regarding the pathogenesis of PPIS with elevated titers of different antibodies and immune complexes in the circulation correlating with disease activity. Nevertheless, cell-mediated response by different subgroups of T lymphocyte has a significant importance with direct infiltration of pericardial tissue and fluids. The diagnosis of PPIS is still challenging. A strong connection between specific serological immunological markers and the disease would be of great value in diagnosis and treatment.

Post-cardiac injury syndrome in the Emergency Department: mini-review

“…PCIS seems to be an autoimmune phenomenon mediated by a combined activation of both cell-mediated and humoral mechanisms 15 . Some observations supporting this association are the latent period between cardiac injury and the onset of PCIS, the correlation between titers of different antibodies (particularly the elevated levels of anti-actin and anti-myosin antibodies) and the clinical occurrence of PCIS and the excellent response to antiinflammatory therapy.…”

“…Some observations supporting this association are the latent period between cardiac injury and the onset of PCIS, the correlation between titers of different antibodies (particularly the elevated levels of anti-actin and anti-myosin antibodies) and the clinical occurrence of PCIS and the excellent response to antiinflammatory therapy. However, the significance of these antibodies and their relation to the severity of myocardial injury is still unclear 15 .…”

Post-cardiac injury syndrome

“…• post-pericardiotomy syndrome (PPS), occurring after cardiac surgery procedures, more frequently after valve replacement (10-40% of patients) [3], • post-myocardial infarction syndrome (PMIS), or Dressler's syndrome with incidence estimated below 5%, which exhibits a tendency for gradual reduction due to widespread, aggressive, and efficacious treatment of acute coronary syndromes [1,4], • post-commissurotomy syndrome (PCS) [1], • post-thoracotomy syndrome (PS) [2].…”

“…The syndrome is more frequently associated with younger age groups (age 47 ±20 on average) [4,5]. It occurs within a period of several days to several months after an operation or myocardial infarction.…”

“…PCIS may be initiated by damage to the pericardium and the presence of blood in the intrapericardial space, causing the development of an inflammatory response [2]. The immunological nature of the condition seems to be confirmed by the delay in the onset of the symptoms in relation to the time of the procedure or myocardial infarction, the sudden improvement after anti-inflammatory treatment and the tendency for recurrence (sometimes related to the discontinuation of corticosteroids), as well as the lack of correlation between PCIS severity and the presence of myocardial injury markers [4]. It is also supposed that the injury leads to the release and presentation of heart antigens, against which various heart tissue-specific and non-organspecific antibodies are produced.…”