Dressler's syndrome

Overview

Dressler's syndrome is a type of pericarditis — inflammation of the sac surrounding the heart (pericardium). Dressler's syndrome is believed to be an immune system response after damage to heart tissue or to the pericardium, from events such as a heart attack, surgery or traumatic injury. Symptoms include chest pain, which may be similar to chest pain experienced during a heart attack.

Dressler's syndrome may also be called postpericardiotomy syndrome, postmyocardial infarction syndrome and post-cardiac injury syndrome.

A heart with pericarditis and a normal heart

The heart on the right shows a heart with pericarditis, in which the membrane (pericardium) that surrounds the heart is swollen and infected. The heart on the left shows a heart with a normal pericardium.

Symptoms

Symptoms are likely to appear weeks to months after a heart attack, surgery or injury to the chest. Symptoms might include:

  • Chest pain
  • Fever

When to see a doctor

Seek emergency care for persistent chest pain, which may indicate a recurring heart attack or other disorder.

Causes

Dressler's syndrome is associated with an immune system response to heart damage. Your body reacts to the injured tissue by sending immune cells and proteins (antibodies) to clean up and repair the affected area. Sometimes this response causes excessive inflammation in the pericardium.

Postpericardiotomy syndrome is a well-known complication that may occur after heart surgery.

Complications

The immune system response that leads to Dressler's syndrome might also cause fluid to accumulate in the membranes around your lungs (pleural effusion).

Rarely, Dressler's syndrome can cause more-serious complications, including:

  • Cardiac tamponade. Inflammation of the pericardium can cause fluids to accumulate in the sac (pericardial effusion). The fluid can put pressure on the heart, forcing it to work harder and reducing its ability to pump blood efficiently.
  • Constrictive pericarditis. Recurring or chronic inflammation can cause the pericardium to become thick or scarred. The scarring can reduce the heart's ability to pump blood efficiently.

Diagnosis

Your doctor will conduct a thorough physical examination, including listening to your heart with a stethoscope. Certain characteristic sounds can indicate that your pericardium is inflamed or that fluid has accumulated around your heart.

Your doctor might then recommend tests, such as:

  • Echocardiogram. Sound waves produce an image of your heart, helping your doctor to see if fluid is collecting around it.
  • Electrocardiogram. Electrical impulses in your heart are recorded through wires attached to your skin. Certain changes in the electrical impulses can indicate pressure on your heart. But electrocardiogram readings may be abnormal after heart surgery, so your doctor likely won't rely on this one test for a diagnosis of Dressler's syndrome.
  • 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. The results of certain tests can indicate inflammatory activity that's consistent with Dressler's syndrome.

Treatment

The goals are to manage pain and reduce inflammation. Your doctor might recommend medications, such as:

  • Aspirin
  • Ibuprofen (Advil, Motrin IB, others)
  • Indomethacin

If those medications don't help, your doctor might prescribe:

  • Colchicine. This anti-inflammatory medication might be used, along with over-the-counter medications, to treat Dressler's syndrome. Some studies suggest that colchicine taken before cardiac surgery might help prevent postpericardiotomy syndrome. The effectiveness of colchicine for treating existing post-cardiac injury syndrome isn't clear.
  • Corticosteroids. These immune system suppressants can reduce inflammation related to Dressler's syndrome. Corticosteroids can have serious side effects and might interfere with the healing of damaged heart tissue after a heart attack or surgery. For those reasons, corticosteroids are generally used only when other treatments don't work.

Treating complications

Complications of Dressler's syndrome can require more-invasive treatments, including:

  • Draining excess fluids. If you develop cardiac tamponade, your doctor will likely recommend a procedure (pericardiocentesis) in which a needle or small tube (catheter) is used to remove the excess fluid. The procedure is usually done using a local anesthetic.
  • Removing the pericardium. If you develop constrictive pericarditis, you might need surgery to remove the pericardium (pericardiectomy).

Preparing for an appointment

If you're being seen in the emergency room for chest pain, you might be asked:

  • When did your symptoms begin?
  • Can you rate the severity of your 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?

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