Dressler syndrome

Overview

Dressler syndrome is a form of secondary pericarditis, an inflammation of the pericardium (the sac surrounding the heart), that occurs after injury to the heart or pericardium. It typically arises weeks to months after a heart attack (myocardial infarction), cardiac surgery, or chest trauma. This condition is considered an autoimmune response in which the body reacts to heart tissue damage by generating inflammation. Dressler syndrome is also known as post-myocardial infarction syndrome or postpericardiotomy syndrome depending on the underlying trigger.

Causes

Dressler syndrome is believed to be caused by an immune-mediated inflammatory reaction following damage to heart tissue. When the heart muscle is injured—such as during a heart attack, surgery, or trauma—proteins from the damaged cells are released into the bloodstream. The immune system may then mistakenly identify these proteins as foreign, triggering inflammation of the pericardium. Common causes include:

• Myocardial infarction (heart attack)

• Open-heart surgery (e.g., coronary artery bypass grafting)

• Cardiac trauma (e.g., stab wounds, blunt injury)

• Pacemaker insertion or other invasive cardiac procedures

Symptoms

Symptoms of Dressler syndrome typically develop within a few weeks to a couple of months after the cardiac event. Common signs and symptoms include:

• Sharp, pleuritic chest pain: Often worsens with deep breathing or lying flat and improves when sitting up.

• Fever: Low-grade and persistent.

• Pericardial friction rub: A scratchy sound heard on auscultation of the chest.

• Malaise and fatigue

• Pericardial effusion: Fluid accumulation around the heart, which can lead to complications like cardiac tamponade in severe cases.

• Pleuritis or pleural effusion: Inflammation of the lung lining or fluid buildup around the lungs, causing breathing difficulty.

Diagnosis

Diagnosis of Dressler syndrome is based on clinical suspicion, especially in patients with recent cardiac injury. Investigations may include:

• Medical history and physical exam: Focused on recent cardiac events and auscultation findings (pericardial rub).

• Electrocardiogram (ECG): May show diffuse ST-segment elevations and PR-segment depressions typical of pericarditis.

• Echocardiogram: To assess for pericardial effusion and rule out cardiac tamponade.

• Chest X-ray: May reveal enlarged cardiac silhouette or pleural effusion.

• Blood tests: Elevated inflammatory markers such as ESR and CRP; cardiac enzymes may or may not be elevated.

Treatment

Treatment of Dressler syndrome is aimed at reducing inflammation and managing symptoms. Common therapies include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): First-line treatment to reduce inflammation and pain (e.g., ibuprofen, aspirin).

• Colchicine: Often used in combination with NSAIDs to reduce recurrence and duration of symptoms.

• Corticosteroids: Reserved for severe or refractory cases; used with caution due to potential adverse effects and increased risk of recurrence.

• Pericardiocentesis: A procedure to drain fluid in cases of large or symptomatic pericardial effusion or tamponade.

• Monitoring: Regular follow-up to monitor resolution of inflammation and detect complications.

Prognosis

With appropriate treatment, the prognosis for Dressler syndrome is generally favorable. Most patients respond well to anti-inflammatory therapy, and symptoms typically resolve within a few weeks. However, recurrence can occur, particularly if treatment is discontinued too early. Severe complications such as cardiac tamponade are rare but require immediate intervention. Long-term outcomes are good with proper medical management, and life expectancy is not significantly affected once the syndrome is resolved.