Dressler’s syndrome is a rare complication that can develop 2-10 weeks post-myocardial infarction or heart surgery. It is a type of pericarditis, which is inflammation of the sac surrounding the heart (the pericardium). The condition is characterized by chest pain, fever, and an elevated white blood cell count.
The exact cause of Dressler’s Syndrome is not known, but it is thought to be an immune response to myocardial injury. Myocardial antigens or neo-antigens from the damaged heart tissue may stimulate the immune system to produce inflammation in the pericardium.
The most common symptom of Dressler’s Syndrome is chest pain, which is usually located in the middle or left side of the chest. The pain is often described as a dull, aching pain, and it may be worse when the person is lying down. Other clinical features can include fever, an elevated white blood cell count and pericardial effusion (a build-up of fluid in the pericardium).
Chest pain is usually:
- Sharp and well-localised
- Relieved by leaning forwards
- Radiates to the left shoulder, down the arm or into the abdomen
- Pericardial rub
- Heart failure
- Pulsus paradoxus (>10 mmHg drop in blood pressure on inspiration) in severe cases
- Kussmaul’s sign (rise of JVP on inspiration) in severe cases
The diagnosis of Dressler’s Syndrome is often made based on the patient’s symptoms and medical history. Clinical features that suggest the diagnosis include:
- Recent history of myocardial infarction
- Low-grade fever
- Chest pain
- Pericardial rub
- ECG: ST elevation in all leads
- Chest x-ray: may show cardiomegaly
- Echocardiography: may show effusion
Treatment for Dressler’s Syndrome typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain. Corticosteroids may also be used in more severe cases. In some cases, pericardiocentesis (the removal of fluid from the pericardium) may be necessary if there are large pericardial effusions.