Dressler's syndrome

Definition

Dressler's syndrome is a type of pericarditis, inflammation of the sac surrounding the heart (pericardium). Inflammation associated with Dressler's syndrome is believed to be an immune system response following damage to heart tissue or the pericardium, such as a heart attack, surgery or traumatic injury.

Dressler's syndrome symptoms include chest pain, much like that experienced during a heart attack, and fever.

With recent improvements in heart attack treatments, Dressler's syndrome is less common than it used to be. However, once you've had this condition, it may recur.

Dressler's syndrome is also known as postpericardiotomy, post-myocardial infarction syndrome and post-cardiac injury syndrome.

Symptoms

Symptoms are likely to appear weeks to months after a heart attack, surgery or other heart injury. Dressler's syndrome symptoms may include:

• Chest pain
• Fever
• Shortness of breath
• Fatigue
• General feeling of not being well

When to see a doctor
See your doctor if you experience any chest pain that lasts more than a few minutes. Other complications following a heart attack, surgery or other heart injury can cause symptoms of Dressler's syndrome. And chest pain may indicate a recurring heart attack or other undiagnosed disorder. Therefore, it's important to get a prompt diagnosis and appropriate treatment.

Causes

Dressler's syndrome is thought to be related to an immune system response to heart tissue damage, such as from a heart attack or heart surgery. Your body reacts to the injured tissue as it would to any injury, by sending immune cells and proteins called antibodies to clean up and repair the affected area. But this response may cause excessive inflammation in the sac enveloping the heart (pericardium).

Complications

Two rare but serious complications of Dressler's syndrome include the following conditions:

• Cardiac tamponade. Inflammation associated with Dressler's syndrome may result in the accumulation of fluids within the pericardium (pericardial effusion). If too much fluid builds up, pressure on the heart forces it to work harder and reduces its ability to pump blood efficiently. This condition is called cardiac tamponade.
• Constrictive pericarditis. This condition develops when recurring or chronic inflammation of the pericardium causes the sac to become thick or scarred. This condition also results in the heart working harder and pumping less efficiently.

Related disorders
The immune system response that leads to Dressler's syndrome may also contribute to accompanying conditions:

• Pleurisy, inflammation of the membranes (pleura) around your lungs
• Pleural effusion, a buildup of pleural fluid around your lungs

Preparing for your appointment

If you're experiencing chest pain that lasts more than a few minutes, get emergency care. When you see the admitting nurse and the doctor in the emergency room, you'll be asked a number of questions, which may include the following:

• When did the symptoms begin?
• Can you rate the severity of chest pain, such as on a scale of 1 to 10?
• Does anything worsen symptoms? For example, does it hurt more when you inhale deeply?
• Where is the pain located? Does it extend anywhere beyond your chest?
• Have you experienced a recent event that could cause tissue damage to the heart, such as a heart attack, heart surgery or blunt trauma to your chest?
• Do you have a history of heart disease?
• What prescription or over-the-counter medications are you taking?
• Who is your primary care physician, heart specialist (cardiologist) or surgeon?

Tests and diagnosis

Your doctor makes a diagnosis of Dressler's syndrome based on questions you answer about your symptoms and the results of an examination and tests. Diagnostic procedures may include the following:

• Listening to your heart. Your doctor will listen to your heart with a stethoscope. If the pericardium is inflamed, your doctor may hear a high-pitched, scratchy sound called a friction rub. If there's a large amount of fluid accumulated, your heartbeat may be muffled or sound distant.
• Echocardiogram. An echocardiogram uses sound waves to produce an image of your heart. This test enables your doctor to see if fluid is collecting around your heart.
• Electrocardiogram. An electrocardiogram records the electrical impulses in your heart through wires attached to the skin on your chest and other locations on your body. Certain changes in the electrical impulses may mean there's pressure on your heart.
• Chest X-ray. An X-ray can help detect fluid building up around the heart or lungs and can help exclude other causes of your symptoms, such as pneumonia.
• Blood tests. Your doctor may draw blood for laboratory tests. The results of certain tests can indicate significant inflammatory activity that's consistent with a diagnosis of Dressler's syndrome.

Treatments and drugs

Treatment goals for Dressler's syndrome are to manage pain and reduce inflammation. Medications commonly used include the following:

• Aspirin
• Ibuprofen (Advil, Motrin, others)
• Naproxen (Aleve, others)

If these drugs don't help, the following drugs may be prescribed:

• Colchicine is an anti-inflammatory drug that may be used to treat persistent or recurring episodes of Dressler's syndrome. Because of potential serious side effects, such as liver and kidney damage, this treatment isn't an option for some people.
• Corticosteroids can suppress inflammation related to Dressler's syndrome. They're used only when other treatments don't work, because of the risk of serious side effects and because corticosteroids may interfere with the healing of damaged heart tissues after a heart attack or surgery.

Treating complications
Complications of Dressler's syndrome require more invasive treatments:

• Draining excess fluids. If the buildup of fluids around the heart disrupts heart function (cardiac tamponade), then you'll likely undergo a procedure called pericardiocentesis. A doctor uses a needle or small tube (catheter) to remove and drain the excess fluid. You'll receive a local anesthetic before the procedure.

• Removing the pericardium. If thickening or scarring of the pericardium reduces heart function (constrictive pericarditis), you may need to have the entire pericardium removed, a surgical procedure called pericardiectomy. The heart is usually able to function normally without the pericardium.