Dressler syndrome

Presentation

Dressler syndrome was historically a phenomenon complicating about 7% of myocardial infarctions, but in the era of percutaneous coronary intervention, it is very uncommon. The disease consists of persistent low-grade fever, chest pain (usually pleuritic), pericarditis (usually evidenced by a pericardial friction rub, chest pain worsening when recumbent, and diffuse ST elevation with PR segment depression), and/or pericardial effusion. The symptoms tend to occur 2–3 weeks after myocardial infarction but can also be delayed a few months. It tends to subside in a few days, and very rarely leads to pericardial tamponade. Elevated ESR is an objective but nonspecific laboratory finding.

Causes

It is believed to result from an autoimmune inflammatory reaction to myocardial neo-antigens formed as a result of the MI. Similar pericarditis can be associated with any pericardiotomy or trauma to the pericardium or heart surgery which is called a postcardiotomy syndrome.

Diagnosis

Differential diagnosis

Dressler syndrome needs to be differentiated from pulmonary embolism, another identifiable cause of pleuritic (and non-pleuritic) chest pain in people who have been hospitalized and/or undergone surgical procedures within the preceding weeks. ischaemic heart disease.

Treatment

The treatment of Dressler syndrome is managed with NSAIDs such as aspirin, naproxen, and ibuprofen. Unless a patient is hemodynamically unstable, management is done in an outpatient setting (e.g. a clinic/office). Indomethacin (also an NSAID) is avoided because it can inhibit new collagen deposition, thus impairing the healing process for the infarcted region. In some resistant cases, corticosteroids can be used but are not preferred (avoided) in the first month due to the high frequency of impaired ventricular healing leading to an increased rate of ventricular rupture. Heparin should be avoided because it can lead to hemorrhage into the pericardial sac, leading to tamponade. The only time heparin could be used with pericarditis is with coexisting acute MI, in order to prevent further thrombus formation.

Some sources suggest that taking colchicine soon after surgery may help prevent Dressler syndrome.

References

References

1. (1 July 1972). "Dressler's syndrome". BMJ.
2. (November 2004). "Is Dressler syndrome dead?". Chest.
3. (April 1984). "Dressler's syndrome after right ventricular infarction". Postgrad Med J.
4. Dressler W. (January 1959). "The post-myocardial-infarction syndrome: a report on forty-four cases". Arch Intern Med.
5. {{WhoNamedIt. synd. 3982
6. (1854). "Ein Fall von intermittierender Albuminurie und Chromaturie". Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin.
7. (1984). "Infarction-associated pericarditis. Rarity of diagnostic electrocardiogram". N Engl J Med.
8. Hertzeanu, H. (1983). "Cardiac tamponade in Dressler's syndrome. Case report.". Cardiology.
9. (July 3, 2023). "Dressler Syndrome.". StatPearls.
10. (August 31, 2024). "Dressler syndrome - Diagnosis and Treatment". Mayo Clinic.
11. (2009). "CURRENT Diagnosis & Treatment: Cardiology". McGraw-Hill.
12. (August 31, 2024). "Dressler syndrome". Mayo Clinic.