Aust. N.Z. J. Med. (1975), 5, pp. 1-2
Pericarditis in Acute Myocardial Infarction K. H. McLean', J. H.
N. Bettt and A.
Saltups:
From Coronary Care Unit, Prince Henry's Hospital, Melbourne
Summary: In 1505 patients with acute myocardial infarction (MI) pericarditis was diagnosed most often in those with anterior transmural ECG changes. Those with pericarditis had a significantly greater hospital mortality and peak serum lactic dehydrogenase (LDH) levels and a greater incidence of left ventricular failure (LVF).
The patients reported here' and our methods of study' have been described. Methods
Pericarditis was recorded if a pericardial friction rub was heard or the patient complained of precordial pain associated with breathing, often altered by changing posture or sitting forward. We have included only those in whom pericarditis appeared during the first week5. Anricoagulants or fibrinolytic agents were used only in patients with a special risk or clinical evidence of thromboembolism, and in a group of 171 patients who were included in the Australian multi-centre trial of streptokinase6.
quent recognition of a friction rub with anterior MI (Fig. 1). We have already commented on the high incidence of atrial fibrillation (22.8%) with pericarditis'. Patients with atrial fibrillation and pericarditis had higher LDH levels (1883 units v. 1639 units) and a greater incidence of LVF (84.3% v. 72.2%) than those with atrial fibrillation alone, although these differences were not significant (P > 0.05). Discussion
Pericarditis is almost certainly unrecognised in many patients with acute MI. Venous congestion or increase in cardiac diameter may well be
Results
Pericarditis was recorded in 14.9% of 1505 patients with acute MI (Table 1). Compared to other patients with acute MI those with pericarditis had a significantly higher hospital mortality, a greater incidence of LVF and higher peak LDH levels. The difference in the CCU mortality was not significant (8.9% v. 11 .4%); most deaths occurred in the general wards after the patients had left the CCU. More than half (53%) of those with pericarditis had anterior infarction, compared to 32% of those without pericarditis (P< 0.0001). This may be partly because of the more fre-
anterior
rub inferior
Associate Professor, M onash University tCardiologist, Royal Brisbane Hospital $Cardiologist. Prince Henry's Hospital, Melbourne Correspondence: Dr. J. H . N. Bett, Royal Brisbane Hospital, Brisbane, Queensland 4029 Accepted for publication: 19 August, 1974
n = 118
n = 66
F I G U R E 1 . Pericarditis and the site of infarction. This diagram represents the number of patients with anterior or inferior infarction diagnosed as having pericarditis on the presence of a rub or pain. The number who died in each group is shown as a subscript.
2
MCLEAS ET AL.
-~
VOL.
5, NO. 1
TABLE 1 Data on patients with pericarditis compared with those without pericarditis in the whole population o f those with acute MI and in the subgroups with anterior and inferior infarction.
of total (II)
Number -
224
Pericarditis and Anterior Infarction
118
Remainder with Anterior Infarction
413
Pericarditis and Inferior Infarction
66
Remainder with Inferior Infarction
50 1
t P < 0.01
:P < 0.001
Mean peak LDH (units)
-~
14.9
1281
Remainder
* P < 0.05
hospital mortality
lo
22.4
11.6
Mean
'
Pericarditis in Acute Myocardial Infarction K. H. McLean', J. H.
N. Bettt and A.
Saltups:
From Coronary Care Unit, Prince Henry's Hospital, Melbourne
Summary: In 1505 patients with acute myocardial infarction (MI) pericarditis was diagnosed most often in those with anterior transmural ECG changes. Those with pericarditis had a significantly greater hospital mortality and peak serum lactic dehydrogenase (LDH) levels and a greater incidence of left ventricular failure (LVF).
The patients reported here' and our methods of study' have been described. Methods
Pericarditis was recorded if a pericardial friction rub was heard or the patient complained of precordial pain associated with breathing, often altered by changing posture or sitting forward. We have included only those in whom pericarditis appeared during the first week5. Anricoagulants or fibrinolytic agents were used only in patients with a special risk or clinical evidence of thromboembolism, and in a group of 171 patients who were included in the Australian multi-centre trial of streptokinase6.
quent recognition of a friction rub with anterior MI (Fig. 1). We have already commented on the high incidence of atrial fibrillation (22.8%) with pericarditis'. Patients with atrial fibrillation and pericarditis had higher LDH levels (1883 units v. 1639 units) and a greater incidence of LVF (84.3% v. 72.2%) than those with atrial fibrillation alone, although these differences were not significant (P > 0.05). Discussion
Pericarditis is almost certainly unrecognised in many patients with acute MI. Venous congestion or increase in cardiac diameter may well be
Results
Pericarditis was recorded in 14.9% of 1505 patients with acute MI (Table 1). Compared to other patients with acute MI those with pericarditis had a significantly higher hospital mortality, a greater incidence of LVF and higher peak LDH levels. The difference in the CCU mortality was not significant (8.9% v. 11 .4%); most deaths occurred in the general wards after the patients had left the CCU. More than half (53%) of those with pericarditis had anterior infarction, compared to 32% of those without pericarditis (P< 0.0001). This may be partly because of the more fre-
anterior
rub inferior
Associate Professor, M onash University tCardiologist, Royal Brisbane Hospital $Cardiologist. Prince Henry's Hospital, Melbourne Correspondence: Dr. J. H . N. Bett, Royal Brisbane Hospital, Brisbane, Queensland 4029 Accepted for publication: 19 August, 1974
n = 118
n = 66
F I G U R E 1 . Pericarditis and the site of infarction. This diagram represents the number of patients with anterior or inferior infarction diagnosed as having pericarditis on the presence of a rub or pain. The number who died in each group is shown as a subscript.
2
MCLEAS ET AL.
-~
VOL.
5, NO. 1
TABLE 1 Data on patients with pericarditis compared with those without pericarditis in the whole population o f those with acute MI and in the subgroups with anterior and inferior infarction.
of total (II)
Number -
224
Pericarditis and Anterior Infarction
118
Remainder with Anterior Infarction
413
Pericarditis and Inferior Infarction
66
Remainder with Inferior Infarction
50 1
t P < 0.01
:P < 0.001
Mean peak LDH (units)
-~
14.9
1281
Remainder
* P < 0.05
hospital mortality
lo
22.4
11.6
Mean
'
