Dressler syndrome

Dr René Pfleger et al.

Dressler syndrome (DS) is the delayed immune-mediated or secondary pericarditis developing weeks to months after a myocardial infarction (MI).

DS is not be confused with pericarditis epistenocardica (which is seen earlier post-MI) and is considered a rare phenomenon in the era of reperfusion (nowadays percutaneous coronary intervention [PCI]). 

Once described as occurring in 1-5% of MIs, incidence has decreased owing to reperfusion (initially thrombolysis and following PCI) and may well be below 0.5% 2-3,5.

Patients typically present from one week to few months after large myocardial infarction.

Typical symptoms include:

  • pleuritic chest pain
  • fever

Typical signs comprise:

  • leukocytosis
  • pericardial friction rub (murmurs by auscultation)

The aetiology is not well understood, and several possible pathomechanisms have been proposed, including local inflammation, autoimmune response and latent viruses. There is a consensus that 2:

  • DS shares similarities with other entities seen after myocardial damage, including
    • postcardiotomy syndrome
    • posttraumatic pericarditis
  • DS is most likely immunomodulated

It is most commonly seen after transmural infarction; however, it may also be seen in milder forms of myocardial infarction 5.

Plain radiograph
CT
  • may reveal pericardial effusion of varying size, may be simple (serous) or more often complex, e.g. haemopericardium 
  • myocardial thinning of the infarcted region and possibly stents in the coronary arteries (status post PCI) may be present
MRI

ECG-gated MR (cardiac MR or CMR) is the imaging modality of choice 4. Findings comprise:

  • intense late post-gadolinium enhancement of entire pericardium
  • typically regional thinning and akinesis of the infarcted myocardium (complication of transmural infarction)

The clinical course is most often benign. Conservative management includes NSAID and colchicine. However, tamponade and free wall rupture may occur, necessitating urgent surgery. Constrictive pericarditis may be a rarely associated complication. Pericardiocentesis with fibrin-glue instillation may be tried 5.

It is named after cardiologist William Dressler (1890-1969), who discovered it in the late 1950s 6.

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Article information

rID: 29269
System: Cardiac
Section: Syndromes
Tag: cases
Synonyms or Alternate Spellings:
  • Dressler syndrome
  • Postinfarction pericarditis
  • Delayed post-MI pericarditis
  • Late post-MI pericarditis

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