From the Guidelines
Dressler's syndrome is a type of pericarditis that occurs as a delayed immune response following heart damage, typically 1-6 weeks after a heart attack, cardiac surgery, or other cardiac injury, and is characterized by chest pain, fever, malaise, and sometimes pericardial effusion. This condition is presumed to have an autoimmune pathogenesis triggered by initial damage to pericardial and/or pleural tissues caused by either myocardial necrosis, surgical trauma, accidental thoracic trauma, or iatrogenic trauma with or without bleeding 1. The immune-mediated pathogenesis is supported by a latent period generally of a few weeks until the appearance of the first manifestations and the response to anti-inflammatory drugs (NSAIDs, corticosteroids, colchicine) with the possibility of recurrences.
Clinical Presentation and Diagnosis
The clinical presentation of Dressler's syndrome includes chest pain, fever, malaise, and sometimes pericardial effusion. The diagnosis is based on the presence of these symptoms, as well as the presence of a pericardial friction rub, and elevated inflammatory biomarkers. It is essential to distinguish Dressler's syndrome from other conditions, such as reinfarction or acute stent thrombosis, and to monitor for complications like cardiac tamponade.
Treatment
Treatment primarily involves anti-inflammatory medications, with aspirin (650-975mg every 4-6 hours) as first-line therapy, usually continued for 1-2 weeks then tapered 1. Colchicine (0.5-0.6mg twice daily) is often added to improve response and prevent recurrence, typically for 3-6 months. For severe cases or those not responding to aspirin, other nonsteroidal agents like ibuprofen (600-800mg three times daily) may be used, although caution should be exercised due to the potential for hemorrhagic conversion. Corticosteroids like prednisone (0.25-0.5mg/kg/day) may be used in rare cases, but their use is potentially harmful and should be avoided if possible 1.
Prognosis and Management
Most patients recover completely with proper treatment, though recurrence is possible. Rest and monitoring for complications like cardiac tamponade are essential during recovery. The use of colchicine has been extrapolated from its efficacy in other settings, and its addition to the treatment regimen may improve response and prevent recurrence. Asymptomatic pericardial effusions are common after STEMI, and it is crucial to exclude rupture when a pericardial effusion is present, especially if the patient is experiencing symptoms like chest pain or shortness of breath 1.
From the Research
Definition and Characteristics
- Dressler's syndrome, also known as post-myocardial infarction syndrome, is a condition characterized by sterile pericarditis that develops shortly after myocardial injury 2.
- It is typically marked by pericardial inflammation, including pericardial effusion, pleuritic chest pain, and elevated inflammatory markers 2.
- The syndrome can lead to serious morbidity, including heart failure, arrhythmias, conduction abnormalities, and cardiac tamponade 3.
Clinical Presentation
- Patients with Dressler's syndrome often present with chest pain, fever, and signs of pericarditis, which can occur weeks after the initial myocardial infarction 4, 2.
- The condition can be diagnosed using electrocardiography, echocardiography, and laboratory tests to evaluate inflammatory markers and pericardial effusion 4, 2.
Treatment Options
- Traditional treatment for Dressler's syndrome involves high-dose aspirin, but this may not be suitable for patients who have undergone recent coronary stenting due to bleeding and thrombotic concerns 4.
- Alternative treatment options include combination therapy with colchicine and acetaminophen, which has been shown to be effective in improving clinical symptoms 4.
- Corticosteroids and indomethacin may also be used to manage the condition, particularly in cases with cardiac tamponade or hemorrhagic pericardial fluid 5, 6.