Dressler’s Syndrome

Introduction

Dressler’s syndrome is pericarditis that develops 2-10 weeks post-myocardial infarction or heart surgery.

Pathophysiology

It is believed to result from an autoimmune reaction to myocardial neo-antigens.

Clinical features

Symptoms

Chest pain is usually:

• Sharp and well-localised
• Relieved by leaning forwards
• Radiates to the left shoulder, down the arm or into the abdomen
• Pleuritic

Signs

• Pericardial rub
• Fever
• 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

Diagnosis

Mostly based on clinical features and suggested by:

• Recent history of myocardial infarction
• Low-grade fever
• Chest pain
• Pericardial rub

Investigations

• ECG: ST elevation in all leads
• Chest x-ray: may show cardiomegaly
• Echocardiography: may show effusion

Management

Non-steroid anti-inflammatory drugs and rest. Consider pericardiocentesis and steroid if severe.