Dressler syndrome

Dressler syndrome, also known as post-myocardial infarction syndrome, is a type of pericarditis—a condition characterized by inflammation of the pericardium, the sac surrounding the heart. It typically occurs after a heart attack (myocardial infarction), heart surgery, or traumatic injury to the heart. First described by William Dressler in 1956, this syndrome remains an important consideration in the care of patients recovering from cardiac events.

Causes and Pathophysiology

Dressler syndrome is believed to be an autoimmune response to heart injury. When the heart muscle is damaged, such as during a heart attack or surgery, the body’s immune system may mistakenly attack the heart’s own tissues, leading to inflammation of the pericardium. This autoimmune reaction is thought to be triggered by the release of cardiac antigens into the bloodstream, which the immune system identifies as foreign, thereby initiating an inflammatory response.

Symptoms

The symptoms of Dressler syndrome usually appear weeks to months after the initial cardiac event. Common symptoms include:

1. Chest Pain: Often sharp and pleuritic, worsening with deep breaths, coughing, or lying down, and improving when sitting up or leaning forward.
2. Fever: A low-grade fever is typical.
3. Pericardial Effusion: Accumulation of fluid in the pericardial sac, which can cause additional discomfort and pressure on the heart.
4. Malaise and Fatigue: General feelings of illness and tiredness.
5. Shortness of Breath: Due to the inflammation and potential fluid buildup around the heart.

Diagnosis

Diagnosis of Dressler syndrome involves a combination of clinical evaluation, patient history, and diagnostic tests. These tests may include:

1. Electrocardiogram (ECG): To detect changes in the heart’s electrical activity indicative of pericarditis.
2. Echocardiogram: To visualize the pericardium and detect any effusion.
3. Chest X-ray: To check for fluid accumulation around the heart and lungs.
4. Blood Tests: To look for markers of inflammation, such as elevated white blood cell count and increased levels of C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR).

Management and Treatment

Treatment of Dressler syndrome focuses on reducing inflammation and managing symptoms. Common treatments include:

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Such as ibuprofen or aspirin, to reduce pain and inflammation.
2. Colchicine: Often used in combination with NSAIDs to help prevent recurrence of symptoms.
3. Corticosteroids: In severe or refractory cases, steroids like prednisone may be prescribed to control inflammation.
4. Pericardiocentesis: In cases of significant pericardial effusion, this procedure involves draining the excess fluid from the pericardial sac.

Prognosis and Follow-Up

With appropriate treatment, most patients with Dressler syndrome experience relief from symptoms and a good prognosis. However, ongoing follow-up is essential to monitor for potential complications, such as recurrent pericarditis or pericardial effusion. Regular check-ups with a healthcare provider and adherence to prescribed treatments are crucial for managing the condition effectively.

Dressler syndrome, though relatively rare, is a significant post-cardiac event complication that requires prompt recognition and treatment. By understanding its causes, symptoms, and management strategies, patients and healthcare providers can work together to ensure optimal recovery and minimize the risk of complications. If you or a loved one has experienced a recent heart event and exhibits symptoms suggestive of Dressler syndrome, seeking medical attention is essential for timely and effective care.