Postinfarction chest pain: Is pericarditis the cause? Maintain a high index of suspicion even after the patient is discharged

Chest pain in a patient who has recently had an acute myocardial infarction (MI) may result from ischemia, pulmonary embolism, or pneumonia. Also consider pericarditis as a possible cause. Early postinfarction pericarditis occurs 2 to 4 days following acute MI, primarily in those with transmural infarction; it is usually heralded by low-grade fever and the development of a pericardial friction rub. Dressler's syndrome usually develops 1 to 28 weeks post-MI and is characterized by pleuropericarditis and constitutional symptoms (such as fever, malaise, myalgia, and arthralgia). Give aspirin as first-line therapy for early postinfarction pericarditis. Aspirin is also preferred for patients with Dressler's syndrome, although other NSAIDs (or brief corticosteroid therapy in complicated or refractory cases) may be used.