Dressler's syndrome
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Overview
Dressler's syndrome is a form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart).
Dressler's syndrome is also known as postmyocardial infarction syndrome[1] and postcardiotomy pericarditis.
Etymology
It was first characterized by William Dressler in 1956.[2][3][4]
It should not be confused with the Dressler's syndrome of haemoglobinuria named for Lucas Dressler, who characterized it in 1854.[5][6]
Presentation
The syndrome consists of a persistent low-grade fever, chest pain (usually pleuritic in nature), a pericardial friction rub, and /or a pericardial effusion. The symptoms tend to occur after a few weeks or even months after infarction and tend to subside in a few days. Signs include elevated ESR.
Causes
It is believed to result from an autoimmune inflammatory reaction to myocardial neo-antigens.
Dressler's syndrome is associated with myocardial infarction (heart attack), and with open heart surgery.
Differential diagnosis
In the setting of myocardial infarction, Dressler's syndrome occurs in about 7% of cases,[7] and typically occurs 2 to 10 weeks after the myocardial infarction occurred. This differentiates Dressler's syndrome from the much more common post myocardial infarction pericarditis that occurs in 17 to 25% of cases of acute myocardial infarction and occurs between days 2 and 4 after the infarction. Dressler's syndrome also needs to be differentiated from pulmonary embolism, another identifiable cause of pleuritic (and non-pleuritic) chest pain in people who have been hospitalized and/or undergone surgical procedures within the preceding weeks.
Treatment
Dressler's syndrome is typically treated with NSAIDs such as aspirin or with corticosteroids.[8]
ACC/AHA Guidelines (DO NOT EDIT)[9]
| “ |
Class I1. Aspirin is recommended for treatment of pericarditis after STEMI. Doses as high as 650 mg orally (entericcoated) every 4 to 6 hours may be needed. (Level of Evidence: B) 2. Anticoagulation should be immediately discontinued if pericardial effusion develops or increases. (Level of Evidence: C) Class IIa1. For episodes of pericarditis after STEMI that are not adequately controlled with aspirin, it is reasonable to administer 1 or more of the following:
Class IIb1. Corticosteroids might be considered only as a last resort in patients with pericarditis refractory to aspirin or NSAIDs. Although corticosteroids are effective for pain relief, their use is associated with an increased risk of scar thinning and myocardial rupture. (Level of Evidence: C) 2. Nonsteroidal anti-inflammatory drugs may be considered for pain relief; however, they should not be used for extended periods because of their effect on platelet function, an increased risk of myocardial scar thinning, and infarct expansion. (Level of Evidence: B) Class III1. Ibuprofen should not be used for pain relief because it blocks the antiplatelet effect of aspirin and it can cause myocardial scar thinning and infarct expansion. (Level of Evidence: B) |
” |
Sources
- The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [9]
- The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [10]
See also
- Diseases of the pericardium
- Postpericardiotomy syndrome
- Myocardial infarction
- Coronary artery bypass graft
References
- ↑ Hutchcroft BJ (1972). "Dressler's syndrome". Br Med J. 3 (5817): 49. PMC 1788531. PMID 5039567. Unknown parameter
|month=ignored (help) - ↑ Bendjelid K, Pugin J (2004). "Is Dressler syndrome dead?". Chest. 126 (5): 1680–2. doi:10.1378/chest.126.5.1680. PMID 15539743. Unknown parameter
|month=ignored (help) - ↑ Streifler J, Pitlik S, Dux S; et al. (1984). "Dressler's syndrome after right ventricular infarction". Postgrad Med J. 60 (702): 298–300. PMC 2417818. PMID 6728756. Unknown parameter
|month=ignored (help) - ↑ Dressler W (1959). "The post-myocardial-infarction syndrome: a report on forty-four cases". AMA Arch Intern Med. 103 (1): 28–42. PMID 13605300. Unknown parameter
|month=ignored (help) - ↑ Template:WhoNamedIt
- ↑ L. A. Dressler. Ein Fall von intermittirender Albuminurie und Chromaturie. Archiv für pathologische Anatomie und Physiologie und für klinische Medicin, 1854, 6: 264-266.
- ↑ Krainin F, Flessas A, Spodick D (1984). "Infarction-associated pericarditis. Rarity of diagnostic electrocardiogram". N Engl J Med. 311 (19): 1211–4. PMID 6493274.
- ↑ Gregoratos G (1990). "Pericardial involvement in acute myocardial infarction". Cardiol Clin. 8 (4): 601–8. PMID 2249214.
- ↑ 9.0 9.1 Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869. Unknown parameter
|month=ignored (help) - ↑ Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. Unknown parameter
|month=ignored (help)