Cardiology doctors in Sahakara Nagar, Bangalore • Pericarditis complicating myocardial infarction Patients who develop more chest pain after an infarct may have developed pericarditis. The pain is usually pleuritic and different in character from the pain of the infarct. It must be distinguished from that due to further ischaemia. The presence of a pericardial rub is a most helpful sign. Early (epistenocardiac) pericarditis is due to irritation of the pericardium as a result of infarction affecting the epicardial surface of the heart. It is the only clinical sign of the infarction being transmural (ECG Q-wave and non-Q-wave infarctions have a considerable overlap in the subendocardial-transmural stakes). Later pericarditis may be an autoimmune condition called Dressler’s syndrome; for some reason its incidence appears to be diminishing.52 Both conditions can usually be controlled by non-steroidal anti-inflammatory agents. Dressler’s may require suppression with steroids but has a tendency to relapse when these are withdrawn. The presence of a rub should be investigated with an echocardiogram If a significant pericardial collection is seen, it may be prudent to withdraw anticoagulant treatment with heparin. There is a small risk that this treatment may increase the risk of developing a haemorrhagic effusion and cardiac tamponade