Post-MI Pericarditis Management

Introduction to Guideline-Directed Therapies

The American College of Cardiology and American Heart Association recommend initiating beta-blocker therapy within the first 24 hours in patients without signs of heart failure, evidence of low-output state, or increased risk for cardiogenic shock 4
Beta-blockers should be continued indefinitely in all patients who have had MI, with or without LV dysfunction, as recommended by the American College of Cardiology 2, 3
The American College of Cardiology and American Heart Association guidelines suggest that ACE inhibitors should be administered within the first 24 hours to all post-MI patients with anterior location, heart failure, or ejection fraction ≤40% 3

Beta-blockers must be started and continued indefinitely in all post-MI patients unless contraindicated, regardless of pericarditis presence, according to the American College of Cardiology 1, 2, 3
Contraindications to beta-blocker therapy include systolic blood pressure <120 mmHg, heart rate >110 bpm at presentation, signs of acute heart failure or cardiogenic shock, and evidence of low-output state, as outlined by the American Heart Association 3, 4

For patients with LVEF <40%, hypertension, diabetes, or heart failure, ACE inhibitors are Class I recommendations and should be continued indefinitely, as recommended by the American College of Cardiology and American Heart Association 4, 5, 6
Even in patients without these high-risk features, ACE inhibitors are reasonable for all post-MI patients (Class IIa), according to the American Heart Association 3

NSAIDs should NOT be initiated and should be discontinued during hospitalization for acute coronary syndromes due to increased risk of major adverse cardiac events, as advised by the American Heart Association 4
The combination of metoprolol and lisinopril with aspirin for pericarditis represents optimal evidence-based care that addresses both the underlying MI and the pericardial complication simultaneously, according to the American College of Cardiology and American Heart Association 1, 2, 3, 4