Postpericardiotomy Syndrome Clinical Presentation

Updated: Dec 30, 2020
  • Author: M Silvana Horenstein, MD; Chief Editor: Howard S Weber, MD, FSCAI  more...
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Symptoms of postpericardiotomy syndrome (PPS) usually develop within 1-6 weeks after surgery involving pericardiotomy. Temperature after the first postoperative week usually reaches 38-39°C orally but may spike as high as 40°C. Despite the high temperature, the patient may not appear ill. The fever usually subsides within 2-3 weeks.

Malaise, chest pain, irritability, and decreased appetite are typical presenting symptoms. Patients may also report dyspnea and arthralgias. Children may report chest pain that worsens with inspiration and during the supine position, but improved while sitting upright and leaning forward. Emesis has also been reported as the main symptom in children with impending cardiac tamponade secondary to postpericardiotomy syndrome. [26]


Physical Examination

Patients often demonstrate tachycardia, muffled heart sounds, and a pericardial friction rub. The pericardial rub disappears either with improvement or with further accumulation of pericardial fluid. Systemic fluid retention and hepatomegaly can also occur in the setting of low cardiac output due to impaired ventricular filling. Pulses paradoxicus may also be evident and is represented by a decrease in systemic blood pressure over 10 mmHg during inspiration and diminished pulse-wave amplitude by palpation of the radial artery. Pleural friction rubs are common. Signs of pneumonitis, including cough, fever, and decreased oxygen saturation, may also be present.