Dressler's syndrome
Encyclopedia
Dressler's 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 a triad of features, fever, pleuritic pain and pericardial effusion.
Dressler's 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
in 1956.
It should not be confused with the Dressler's syndrome of haemoglobinuria named for Lucas Dressler, who characterized it in 1854.
, chest pain
(usually pleuritic in nature), a pericardial friction rub
, and /or a pericardial effusion
. The symptoms tend to occur 2 weeks post myocardial infarction, but can be delayed for a few months after infarction. It tends to subside in a few days. An elevated ESR
is an objective laboratory finding.
s formed as a result of the MI
. A similar pericarditis can be associated with any pericardiotomy or trauma to the percardium or heart surgery
.
such as aspirin
or with corticosteroids. However corticosteroids are reserved for rare cases and are seldom required.
Pericarditis
Pericarditis is an inflammation of the pericardium . A characteristic chest pain is often present.The causes of pericarditis are varied, including viral infections of the pericardium, idiopathic causes, uremic pericarditis, bacterial infections of the precardium Pericarditis is an inflammation of...
that occurs in the setting of injury to the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
or the pericardium
Pericardium
The pericardium is a double-walled sac that contains the heart and the roots of the great vessels.-Layers:...
(the outer lining of the heart). It consists of a triad of features, fever, pleuritic pain and pericardial effusion.
Dressler's 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
William Dressler
William Dressler was a cardiologist born in Poland.Dressler's syndrome is named for him.The "Dressler beat", a type of QRS complex, is also named for him.-References:...
in 1956.
It should not be confused with the Dressler's syndrome of haemoglobinuria named for Lucas Dressler, who characterized it in 1854.
Presentation
Dressler's syndrome is largely a self limiting disease that very rarely leads to pericardial tamponade. The syndrome consists of a persistent low-grade feverFever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, chest pain
Chest pain
Chest pain may be a symptom of a number of serious conditions and is generally considered a medical emergency. Even though it may be determined that the pain is non-cardiac in origin, this is often a diagnosis of exclusion made after ruling out more serious causes of the pain.-Differential...
(usually pleuritic in nature), a pericardial friction rub
Pericardial friction rub
A pericardial friction rub, also pericardial rub, is an audible medical sign used in the diagnosis of pericarditis. Upon auscultation, this sign is an extra heart sound of to-and-fro character, typically with three components, two systolic and one diastolic. It resembles the sound of squeaky...
, and /or a pericardial effusion
Pericardial effusion
Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. Because of the limited amount of space in the pericardial cavity, fluid accumulation will lead to an increased intrapericardial pressure and this can negatively affect heart function...
. The symptoms tend to occur 2 weeks post myocardial infarction, but can be delayed for a few months after infarction. It tends to subside in a few days. An elevated ESR
Erythrocyte sedimentation rate
The erythrocyte sedimentation rate , also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment in a period of 1 hour...
is an objective laboratory finding.
Causes
It is believed to result from an autoimmune inflammatory reaction to myocardial neo-antigenAntigen
An antigen is a foreign molecule that, when introduced into the body, triggers the production of an antibody by the immune system. The immune system will then kill or neutralize the antigen that is recognized as a foreign and potentially harmful invader. These invaders can be molecules such as...
s formed as a result of the MI
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...
. A similar pericarditis can be associated with any pericardiotomy or trauma to the percardium or heart surgery
Cardiac surgery
Cardiovascular surgery is surgery on the heart or great vessels performed by cardiac surgeons. Frequently, it is done to treat complications of ischemic heart disease , correct congenital heart disease, or treat valvular heart disease from various causes including endocarditis, rheumatic heart...
.
Differential diagnosis
In the setting of myocardial infarction, Dressler's syndrome occurs in about 7% of cases, and typically occurs 2-3 weeks post-myocardial infarction. Dressler's syndome is also known as post-myocardial infarction syndrome, post-cardiac injury syndrome and postpericardiotomy syndrome. Dressler's 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's syndrome is typically treated with NSAIDsNon-steroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
such as aspirin
Aspirin
Aspirin , also known as acetylsalicylic acid , is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. It was discovered by Arthur Eichengrun, a chemist with the German company Bayer...
or with corticosteroids. However corticosteroids are reserved for rare cases and are seldom required.