### Date : 2024-11-03 14:16 ### Topic : Dressler’s syndrome #cardiology ---- **Dressler’s syndrome** is a type of **pericarditis** that occurs after injury to the heart or pericardium. It’s also known as **post-myocardial infarction (MI) syndrome** or **post-cardiac injury syndrome**. Dressler’s syndrome is believed to be an **autoimmune reaction** where the body’s immune system mistakenly attacks the pericardium after a heart injury, **typically days to weeks after a myocardial infarction (MI), cardiac surgery, or traumatic injury to the heart.** ### Pathophysiology The exact mechanism of Dressler’s syndrome is not fully understood, but it’s generally thought to be an **autoimmune response**. 1. **Heart Injury**: Damage to the heart muscle (e.g., from an MI or cardiac surgery) releases cardiac antigens into the bloodstream. 2. **Immune Response**: The immune system forms antibodies against these cardiac antigens, causing an inflammatory response. 3. **Autoimmune Reaction in the Pericardium**: The antibodies and immune cells attack the pericardium, leading to inflammation, fluid accumulation, and symptoms characteristic of pericarditis. ### Causes and Risk Factors Dressler’s syndrome can develop after any injury to the heart muscle or pericardium, including: - **Myocardial Infarction (Heart Attack)**: The most common cause, typically developing 1-6 weeks after the MI. - **Cardiac Surgery**: Especially common after open-heart procedures like coronary artery bypass grafting (CABG) or valve replacement surgery. - **Blunt or Penetrating Trauma to the Chest**: Injuries that impact the heart can also trigger this autoimmune reaction. - **Percutaneous Coronary Intervention (PCI)**: Less commonly, Dressler’s syndrome can occur after procedures like angioplasty or stent placement. ### Symptoms of Dressler’s Syndrome Symptoms of Dressler’s syndrome are similar to those of pericarditis and typically include: 1. **Chest Pain**: - **Sharp, Pleuritic Pain**: Often worsens with deep breathing, coughing, or lying down, and improves when sitting up or leaning forward. - Pain can mimic angina or recurrent MI, though it is typically more positional. 2. **Fever**: - A low-grade fever is common due to the inflammatory response. 3. **Pericardial Friction Rub**: - A characteristic scratching or rubbing sound heard on auscultation, best heard at the left sternal border with the patient leaning forward. 4. **Dyspnea (Shortness of Breath)**: - Particularly if there is a pericardial effusion or pleural effusion (fluid in the pericardial or pleural space). 5. **Fatigue and Malaise**: - Patients may experience a general feeling of illness or malaise. ### Complications Complications of Dressler’s syndrome can include: - **Pericardial Effusion**: Fluid buildup in the pericardial sac, which can compress the heart and impair function. - **Cardiac Tamponade**: A life-threatening condition where pericardial fluid compresses the heart, limiting its ability to fill and pump blood. - **Constrictive Pericarditis**: Chronic inflammation can sometimes lead to scarring and thickening of the pericardium, which restricts the heart’s movement. ### Diagnosis Diagnosis of Dressler’s syndrome is based on clinical presentation, EKG findings, imaging, and blood tests: 1. **Electrocardiogram (ECG)**: - Shows **diffuse ST-segment elevation** and **PR-segment depression** across multiple leads, similar to pericarditis. 2. **Echocardiography**: - Used to detect pericardial effusion and assess for signs of cardiac tamponade. 3. **Chest X-Ray**: - Can reveal an enlarged cardiac silhouette if there is a significant pericardial effusion. - May show pleural effusion, which is common in Dressler’s syndrome. 4. **Blood Tests**: - **Elevated Inflammatory Markers**: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are usually elevated. - **Leukocytosis**: Increased white blood cell count may be seen. - **Cardiac Enzymes**: Mildly elevated troponin levels can be seen but are typically lower than levels during an acute MI. ### Treatment Treatment for Dressler’s syndrome focuses on reducing inflammation and managing symptoms. Common treatments include: 1. **Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)**: - First-line treatment to reduce inflammation and relieve pain, typically **ibuprofen** or **aspirin**. 2. **Colchicine**: - Often added to reduce inflammation and prevent recurrence. Colchicine is usually continued for 3-6 months. 3. **Corticosteroids**: - Reserved for cases that do not respond to NSAIDs or colchicine, as corticosteroids can increase the risk of recurrence. Prednisone may be used if symptoms are severe or if there is an underlying autoimmune component. 4. **Pericardiocentesis**: - Required if there is a large pericardial effusion causing cardiac tamponade, where fluid is aspirated to relieve pressure on the heart. 5. **Antibiotics**: - Not typically required, as Dressler’s syndrome is an inflammatory condition rather than an infection. ### Prognosis The prognosis for Dressler’s syndrome is generally good with appropriate treatment, but it requires monitoring for complications like pericardial effusion or tamponade. Most cases resolve within weeks to a few months with treatment, though some patients may experience recurrent episodes of pericarditis. ### Summary - **Dressler’s syndrome** is a form of pericarditis that occurs after myocardial infarction, cardiac surgery, or trauma, due to an autoimmune response against the pericardium. - **Symptoms**: Include pleuritic chest pain, fever, and pericardial friction rub, often accompanied by fatigue and dyspnea. - **Diagnosis**: Based on clinical symptoms, ECG findings, inflammatory markers, and echocardiography. - **Treatment**: Involves NSAIDs, colchicine, and occasionally corticosteroids. Pericardiocentesis may be needed in cases of tamponade. While Dressler’s syndrome is usually self-limiting, it requires prompt diagnosis and treatment to manage symptoms and prevent complications. ### Reference: - ### Connected Documents: -