Evaluation and Management of Post-Cardiotomy Syndrome

Post-cardiac injury syndrome (PCIS) encompasses inflammatory pericardial syndromes occurring after cardiac injury, including post-pericardiotomy syndrome (PPS) following cardiac surgery, post-myocardial infarction (Dressler syndrome), and post-traumatic pericarditis. With the expanding use of cardiac surgical and interventional procedures, PCIS has become increasingly prevalent despite a marked decline in Dressler syndrome in the contemporary reperfusion era. The syndrome is believed to result from an immune-mediated inflammatory response to myocardial and pericardial injury, leading to pericarditis with associated pericardial and, often, pleural effusions. Clinical presentation typically occurs days to weeks after the inciting event and includes fever, pleuritic chest pain, elevated inflammatory markers, and imaging evidence of pericardial effusion. Early recognition is essential, as prompt treatment can relieve symptoms and prevent complications such as cardiac tamponade or progression to constrictive pericarditis. First-line therapy consists of high-dose aspirin or nonsteroidal anti-inflammatory drugs combined with colchicine, which accelerates symptom resolution and reduces recurrence. In refractory or recurrent cases, corticosteroids or interleukin-1 inhibitors, such as anakinra, are effective. Prophylactic colchicine administered around the time of cardiac surgery significantly reduces the incidence of post-pericardiotomy syndrome. This review summarizes current evidence and incorporates the 2025 European Society of Cardiology guidelines to guide optimal evaluation and management of PCIS.