Dressler syndrome

Dressler syndrome
Classification and external resources
Specialty cardiology
ICD-10 I24.1
ICD-9-CM 411.0
DiseasesDB 3947

Dressler syndrome is a secondary form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion.

Dressler syndrome is also known as postmyocardial infarction syndrome[1] and the term is sometimes used to refer to post-pericardiotomy pericarditis.

It was first characterized by William Dressler at Maimonides Medical Center in 1956.[2][3][4]

It should not be confused with the Dressler's syndrome of haemoglobinuria named for Lucas Dressler, who characterized it in 1854.[5][6]

Presentation

Dressler syndrome occurs in about 7% of myocardial infarctions,[7] and consists of a persistent low-grade fever, chest pain (usually pleuritic in nature), pericarditis (usually evidenced by a pericardial friction rub), and/or a pericardial effusion. The symptoms tend to occur 2–3 weeks after myocardial infarction, but can also be delayed for a few months. It tends to subside in a few days, and very rarely leads to pericardial tamponade.[8] An elevated ESR is an objective laboratory finding.

Causes

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

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.

Treatment

Dressler syndrome is best treated with high dose aspirin. In some resistant cases, corticosteroids can be used but are not preferred (avoided) in first month due to the high frequency of impaired ventricular healing leading to increased rate of ventricular rupture. NSAIDs though once used to treat Dressler syndrome, are less advocated and should be avoided in patients with ischemic heart disease. One NSAID in particular, indomethacin can inhibit new collagen deposition thus impairing the healing process for the infarcted region. NSAIDS should only be used in cases refractory to aspirin. Heparin in Dressler syndrome 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.[9]

References

  1. ↑ Hutchcroft BJ (July 1972). "Dressler's syndrome". Br Med J 3 (5817): 49. doi:10.1136/bmj.3.5817.49-a. PMC 1788531. PMID 5039567.
  2. ↑ Bendjelid K, Pugin J (November 2004). "Is Dressler syndrome dead?". Chest 126 (5): 1680–2. doi:10.1378/chest.126.5.1680. PMID 15539743.
  3. ↑ Streifler J, Pitlik S, Dux S; et al. (April 1984). "Dressler's syndrome after right ventricular infarction". Postgrad Med J 60 (702): 298–300. doi:10.1136/pgmj.60.702.298. PMC 2417818. PMID 6728756.
  4. ↑ Dressler W (January 1959). "The post-myocardial-infarction syndrome: a report on forty-four cases". AMA Arch Intern Med 103 (1): 28–42. doi:10.1001/archinte.1959.00270010034006. PMID 13605300.
  5. ↑ synd/3982 at Who Named It?
  6. ↑ L. A. Dressler. Ein Fall von intermittirender Albuminurie und Chromaturie. Archiv für pathologische Anatomie und Physiologie und für klinische Medicin, 1854, 6: 264-266.
  7. ↑ Krainin F, Flessas A, Spodick D (1984). "Infarction-associated pericarditis. Rarity of diagnostic electrocardiogram". N Engl J Med 311 (19): 1211–4. doi:10.1056/NEJM198411083111903. PMID 6493274.
  8. ↑ Hertzeanu, H; Almog, C; Algom, M (1983). "Cardiac tamponade in Dressler's syndrome. Case report.". Cardiology 70 (1): 31–6. doi:10.1159/000173566. PMID 6850684.
  9. ↑ Jaffe AS, Boyle AJ. Chapter 5. Acute Myocardial Infarction. In: Crawford MH, ed. CURRENT Diagnosis & Treatment: Cardiology. 3rd ed. New York: McGraw-Hill; 2009. http://www.accessmedicine.com/content.aspx?aID=3646487. Accessed June 16, 2012

External links

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