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PPS Treatment and COPPS Trial — EECC MCQ

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EasyPericardial DiseasePPS Treatment and COPPS TrialEECC

A 52-year-old man presents with chest pain and dyspnoea 3 weeks after cardiac surgery (AVR). He develops fever, pleuritic chest pain, and a pericardial friction rub. ECG shows diffuse ST elevation. CRP is 65 mg/L. White cell count is mildly elevated. What is the diagnosis?

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Correct answer: E — Post-pericardiotomy syndrome (PPS) — an inflammatory pericarditis occurring 2-6 weeks after cardiac surgery; treated with aspirin/NSAIDs plus colchicine, analogous to acute pericarditis

Post-pericardiotomy syndrome (PPS) is a form of pericarditis occurring in 10-40% of patients 2-6 weeks after cardiac surgery. It is an immune-mediated inflammatory response to pericardial injury and blood in the pericardial space. Diagnosis requires: fever, pleuritic chest pain, pericardial friction rub, new/worsening pericardial effusion, elevated inflammatory markers (CRP, ESR, WCC), and exclusion of other causes (wound infection, endocarditis, PE). Treatment: (1) aspirin or NSAIDs (preferred over ibuprofen post-cardiac surgery due to aspirin's antiplatelet effect in patients with prosthetic valves/grafts); (2) colchicine for 3 months (COPPS and COPPS-2 trials demonstrated that colchicine reduces PPS incidence when started perioperatively and treats established PPS). Corticosteroids are second-line due to recurrence risk.

Reference: ESC (2025): Myocarditis/Pericarditis Guidelines; COPPS Trial