Dressler syndrome is a secondary form of

pericarditis Pericarditis () is inflammation of the pericardium, the fibrous sac surrounding the heart. Symptoms typically include sudden onset of sharp chest pain, which may also be felt in the shoulders, neck, or back. The pain is typically less severe whe ...

that occurs in the setting of injury to the

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

or the

pericardium The pericardium (: pericardia), also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong inelastic connective tissue (fibrous pericardium), ...

(the outer lining of the heart). It consists of fever, pleuritic pain, pericarditis and/or pericardial effusion. Dressler syndrome is also known as postmyocardial infarction syndrome and the term is sometimes used to refer to post-pericardiotomy pericarditis. It was first characterized by William Dressler at

Maimonides Medical Center Maimonides Medical Center is a non-profit, non-sectarian hospital located in Borough Park, in the New York City borough of Brooklyn, in the U.S. state of New York. Maimonides is both a treatment facility and academic medical center with 711 ...

in 1956. It should not be confused with Dressler's syndrome of haemoglobinuria named for Lucas Dressler, who characterized it in 1854.

Presentation

Dressler syndrome was historically a phenomenon complicating about 7% of myocardial infarctions, but in the era of

percutaneous coronary intervention Percutaneous coronary intervention (PCI) is a minimally invasive non-surgical procedure used to treat stenosis, narrowing of the coronary artery, coronary arteries of the heart found in coronary artery disease. The procedure is used to place and ...

, it is very uncommon. The disease consists of persistent low-grade

fever Fever or pyrexia in humans is a symptom of an anti-infection defense mechanism that appears with Human body temperature, body temperature exceeding the normal range caused by an increase in the body's temperature Human body temperature#Fever, s ...

chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...

(usually

pleuritic Pleurisy, also known as pleuritis, is inflammation of the membranes that surround the lungs and line the chest cavity (pleurae). This can result in a sharp chest pain while breathing. Occasionally the pain may be a constant dull ache. Other sy ...

), 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 A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. The pericardium is a two-part membrane surrounding the heart: the outer fibrous Connective tissue, connective membrane and an inner two-layered serous membrane ...

. 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 Cardiac tamponade, also known as pericardial tamponade (), is a compression of the heart due to pericardial effusion (the build-up of pericardial fluid in the sac around the heart). Onset may be rapid or gradual. Symptoms typically include those ...

. Elevated ESR is an objective but nonspecific laboratory finding.

Causes

It is believed to result from an

autoimmune In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an " autoimmune disease" ...

inflammatory reaction to myocardial neo-

antigen In immunology, an antigen (Ag) is a molecule, moiety, foreign particulate matter, or an allergen, such as pollen, that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune response. ...

s 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 Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invol ...

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 Colchicine is a medication used to prevent and treat gout, to treat familial Mediterranean fever and Behçet's disease, and to reduce the risk of myocardial infarction. The American College of Rheumatology recommends colchicine, nonstero ...

soon after surgery may help prevent Dressler syndrome.

References

External links

{{DEFAULTSORT:Dressler syndrome Syndromes affecting the heart