Dressler syndrome

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Dressler syndrome
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Overview

Dressler syndrome is a type of pericarditis that occurs in the setting of cardiac injury or trauma to the pericardium. Also known as postmyocardial infarction syndrome, Dressler syndrome is sometimes referred as post-pericardiotomy pericarditis. The symptoms mainly consist of fever, pleuritic pain, pericarditis and pericardial effusion.

Causes:

Dressler's syndrome is believed to be caused due to autoimmune inflammatory reaction to myocardial neo-antigens, which are formed as a result of the Myocardial Infarction. A similar type of pericarditis can be associated with any pericardiotomy or pericardial trauma or heart surgery.

Signs and symptoms:

Main signs and symptoms Dressler syndrome include persistent low-grade fever, chest pain (pleuritic in nature), pericarditis (swelling and irritation of the thin, sac-like membrane surrounding the heart, usually evidenced by a pericardial friction rub), and pericardial effusion (excess fluid between the heart and the sac surrounding the heart). The symptoms have a tendency to occur approximately 2–3 weeks after myocardial infarction, but can be delayed for a few months as well. The symptoms tend to subside in a few days, and pericardial tamponade results very rarely.

Complications:

Cardiac tamponade is one of the complications of Dressler's syndrome. In cardiac tamponade, pericardial inflammation can lead to accumulation of fluids in the sac (pericardial effusion). This accumulated fluid can put pressure on the heart, reducing its ability to pump blood, and forcing it to pump harder. Constrictive pericarditis is another complication of the Dressler's syndrome in chronic inflammation can cause the pericardium to scarred, which reduces the heart's ability to pump blood efficiently.

Diagnosis:

Diagnosis of Dressler's syndrome is made by medical history, clinical examination, cardiac evaluation, echocardiogram, electrocardiogram, chest X-ray and blood tests for inflammatory markers.

Management:

The best management of Dressler syndrome is done with high dose aspirin. In some refractory cases, corticosteroids can be used, though generally avoided in first month due to the high frequency of impaired ventricular healing leading to high chance of ventricular rupture. NSAIDs other than aspirin are not actively advocated and better avoided in patients with ischemic heart disease. Indomethacin, in particular, is known to inhibit new collagen deposition thus impairing the healing of the infarcted region. Heparin should be avoided because it can lead to torrential bleeding into the pericardial sac leading to pericardial tamponade. Patient must be given bed rest with adequate pain control, temperature control and adequate nutrition. If cardiac tamponade is developed as a complication, pericardiocentesis is performed, in which a needle or small catheter is used to remove the excess fluid. If the patient develops constrictive pericarditis, surgery might be needed to remove the pericardium (pericardiectomy).