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Dressler syndrome (DS) is a delayed immune-mediated or secondary pericarditis developing weeks to months after a myocardial infarction (MI).
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Dressler syndrome is not to be confused with pericarditis epistenocardica (which is seen earlier in the post-myocardial infarction period) and is considered a rare phenomenon in the era of reperfusion (nowadays percutaneous coronary intervention [PCI]).
Once described as occurring in 1-5% of myocardial infarctions, the incidence has decreased owing to reperfusion (initially thrombolysis and following percutaneous coronary intervention) and may well be below 0.5% 2-3,5.
Patients typically present from one week to a few months after large myocardial infarction.
Typical symptoms include:
- pleuritic chest pain
- general malaise
Typical signs comprise:
- leukocytosis and raised inflammatory markers
- pericardial friction rub (murmurs by auscultation)
It is common for pericardial effusion to develop but tamponade is rare.
The etiology 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:
- Dressler syndrome shares similarities with other entities seen after myocardial damage, including
- postcardiotomy syndrome
- posttraumatic pericarditis
- Dressler syndrome 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.
- may show nonspecific cardiac enlargement
- see also the main article on pericarditis
- there may be co-existing pleural effusion
- may reveal pericardial effusion of varying size, may be simple (serous) or more often complex, e.g. hemopericardium
- myocardial thinning of the infarcted region and possibly stents in the coronary arteries (status post percutaneous coronary intervention) may be present
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 ( a complication of transmural infarction)
Treatment and prognosis
The clinical course is most often benign. Conservative management includes NSAIDs 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.
History and etymology
It is named after cardiologist William Dressler (1890-1969), who discovered it in the late 1950s 6.
- see main article for pericarditis
- 1. Goldman L, Schafer AI. Goldman's Cecil Medicine: Expert Consult Premium Edition - Enhanced Online Features and Print, Single Volume. Saunders. ISBN:1437716040. Read it at Google Books - Find it at Amazon 77, 473-481
- 2. Bendjelid K, Pugin J. Is Dressler syndrome dead?. Chest. 2004;126 (5): 1680-2. doi:10.1378/chest.126.5.1680 - Pubmed citation
- 3. Hendry C, Liew CK, Chauhan A et-al. A life-saving case of Dressler's syndrome. Eur Heart J Acute Cardiovasc Care. 2012;1 (3): 232-5. doi:10.1177/2048872612452319 - Free text at pubmed - Pubmed citation
- 4. Lawley C, Mazhar J, Grieve SM et-al. Visualizing pericardial inflammation in Dressler's syndrome with cardiac magnetic resonance imaging. Int. J. Cardiol. 2013;168 (1): e32-3. doi:10.1016/j.ijcard.2013.05.082 - Pubmed citation
- 5. Maisch B, Seferović PM, Ristić AD et-al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur. Heart J. 2004;25 (7): 587-610. doi:10.1016/j.ehj.2004.02.002 - Pubmed citation
- 6. Dressler W. The post-myocardial-infarction syndrome: a report on forty-four cases. AMA Arch Intern Med. 1959;103 (1): 28-42. Pubmed citation