Pericarditis after Myocardial Infarction

A 61-year-old man with no previous history of coronary artery disease presented with an acute ST-elevation myocardial infarction (MI). He was promptly taken for cardiac catheterization and stenting of an occluded obtuse marginal artery. He received abciximab during the procedure and for the next 12 hours. He tolerated the procedure without immediate complication; however, post-catheterization echocardiography revealed pericarditis, with a moderate-sized pericardial effusion. During the next few days, serial echocardiograms revealed enlargement of the pericardial effusion. Given that there were concerns about arterial perforation or perhaps free wall rupture, cardiac magnetic resonance imaging was performed (Figs. 1–4 1,2). Fig. 1 Cine balanced Fast Field Echo (FFE) magnetic resonance image of the left ventricle (2-chamber, long-axis view) reveals a moderate-sized pericardial effusion. Black arrows denote visceral pericardium overlying epicardial fat. White arrows point ... Fig. 2 Cine balanced Fast Field Echo (FFE) magnetic resonance image (short-axis view). Arrows point to pericardial effusion that completely surrounds the heart. Fig. 3 Cine T1-Rho magnetic resonance image (oblique 4-chamber view) shows acute myocardial injury as areas of higher signal intensity (lateral wall of left ventricle). The dark band within the infarcted territory is microvascular obstruction (arrow), ... Fig. 4 Delayed-enhancement “scar” magnetic resonance imaging (short-axis view) shows normal viable myocardium as dark black and nonviable myocardium (scar) as bright white. Again, the dark band within the bright white infarcted area is ...