Dressler syndrome
Dressler syndrome is a late, immune-mediated post-myocardial-infarction pericarditis occurring weeks after an infarct (or cardiac injury), presenting with pleuritic chest pain, fever, a pericardial rub, and a pericardial or pleural effusion. Diagnosis is clinical with ECG and echocardiography, and treatment is high-dose aspirin or NSAIDs plus colchicine, avoiding other NSAIDs and steroids early after MI.
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What this article covers
- Overview
Definition: Dressler syndrome is a late, immune-mediated pericarditis occurring weeks after myocardial infarction or other cardiac injury (a post-cardiac-injury syndrome).
- Epidemiology
Now uncommon, its incidence having fallen in the reperfusion era.
- Risk factors
Recent myocardial infarction, especially large or transmural.
- Pathophysiology
Autoimmune reaction: myocardial or pericardial injury exposes cardiac antigens, provoking an antibody-mediated inflammatory response against the pericardium and pleura.
- Clinical features
Pleuritic chest pain: sharp, positional pain worse lying flat and improved sitting forward.
- Differential diagnosis
Early peri-infarction pericarditis: pericardial inflammation from direct epicardial injury, distinguished by its onset within days of the infarct rather than the weeks-long immune-mediated latency of Dressler syndrome (acute pericarditis).
- Diagnosis
Diagnose clinically as post-cardiac-injury pericarditis using the pericarditis criteria in the right time frame: the diagnostic basis is meeting acute pericarditis criteria (at least two of pleuritic…
- Management
First-line, high-dose aspirin plus colchicine (post-MI preferred): aspirin 650 to 1000 mg PO three times daily with a taper, plus colchicine 0.5 mg PO once or twice daily for about 3 months; aspirin…
- Complications
Pericardial effusion and cardiac tamponade (cardiac tamponade).
- Prognosis
Generally good: most cases resolve with aspirin/NSAID plus colchicine.
- Prevention
Colchicine reduces recurrence and is used for the standard course (colchicine 0.5 mg PO once or twice daily for about 3 months) after diagnosis.
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Acute pericarditis is inflammation of the pericardium, most often viral or idiopathic, presenting with pleuritic chest pain relieved by sitting forward, a pericardial friction rub, and diffuse ST elevation with PR depression. Treatment is an NSAID plus colchicine, and the main hazards are effusion, tamponade, and recurrence.
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