Dressler Syndrome


Dressler Syndrome Definition

Dressler syndrome is a kind of inflammation around the heart (specifically to the pericardium and pleura). It occurs due to an immune system response after damage to the heart happens. Events likely to cause this damage are heart attack, injuries or surgery. Chest pain is a symptom and it is similar to heart attack chest pain. Dressler’s syndrome usually happens weeks after the initial event but can happen months later as well.

Dressler syndrome is also known as post pericardiotomy syndrome (PPS), post cardiac injury syndrome and post myocardial infarction syndrome.

Dressler’s syndrome after heart surgery is when it most commonly happens (when the pericardium has been opened). It tends to happen in 2 to 30 percent of the time in these people. Dressler syndrome has also been seen after myocardial infarction. It has also been seen after instances of coronary stent implantation, implantation of pacemakers and trauma like stab wounds or heart punctures.

Dressler’s syndrome is usually associated with pericardial effusion. These may evolve into postoperative/recurrent cardiac tamponade (fluid builds up around the pericardium). Dressler syndrome usually happens once but has been known to recur, even years later. It is uncommon to see Dressler syndrome in children less than two years old. The frequency of Dressler syndrome increases with age.


Dressler syndrome was first described by William Dressler in 1956. Dressler syndrome should not be confused with Dressler’s syndrome from Lucas Dressler that describes haemoglobinuria. [1, 2, 3, 4]

dressler syndrome


Signs and Symptoms

  • Pericardial pain (chest pain from the heart)
  • Pleuritic pain (chest pain from the lungs)
  • Friction rubs (audible sign of pericarditis)
  • Dressler’s syndrome pleural effusion (excess fluid in the lungs)
  • Pneumonitis (inflammation in the walls of the lungs)
  • Abnormal ECG
  • Abnormal radiology findings
  • Low grade fever
  • Dressler syndrome pericarditis
  • May have accompanying pleural effusion
  • Pain may be on the left shoulder in addition to the chest and is worse when lying down
  • Malaise
  • Dyspnea (difficulty breathing)
  • Sometimes can see it with cardiac tamponade (fluid buildup around the heart)
  • Elevated ESR on the lab reports

dressler syndrome

Causes

The precise cause is not known. Dressler syndrome is thought to happen because of an immune system response to the damage in the heart. The body sends anti-bodies and immune cells to the site to clean up the affected area. This response can cause inflammation in the heart. Dressler’s syndrome affects 10 to 40 percent of people who had heart surgery. [1, 2]


Diagnosis

  • Physical examination, including listening to the heart
  • Echocardiogram, ultrasound to see the heart and any fluid around it
  • Electrocardiogram, electrical impulses in the heart are recorded and assessed for pressure on the heart
  • Chest X-ray, to see the heart/lungs and any fluid around them
  • Blood work, will show any inflammatory responses in the body
  • MRI, can show effusions

dressler syndrome

A. shows pericardial effusion and bilateral pleural effusion. B. shows dense anterior anatomy, pressure of the pericardium. [5]

Differential Diagnosis

  • Pulmonary embolism
  • Angina
  • Myocardial infarction
  • Pneumonia

Treatment

The use of high dose Aspirin is the best treatment for Dressler syndrome. Corticosteroids can also be used in resistant cases but they are usually avoided due to high frequency of poor ventricular healing. This leads to an increased rate of ventricular rupture. NSAIDs can be used but are usually less advocated for and should be avoided in those with ischemic heart disease. Some NSAIDs like Indomethacin can delay healing. NSAIDs should be used when Aspirin cannot be used. Heparin should be avoided as a treatment in Dressler syndrome because it can cause bleeding in the pericardial sac and can lead to tamponade. The one time when Heparin can be used in Dressler syndrome is when there is an acute co-existing myocardial infarction, so prevention of thrombus formation can be achieved. Colchicine for Dressler syndrome; It can be used in some cases. Colchicine can also be used before surgery to help prevent post pericardiotomy.

Aspiration of fluid in significant pericardial effusion can be warranted to relieve pressure. When people develop constrictive inflammation of the pericardium then surgery to remove the pericardium may be suggested. [2, 3, 4]

pericardial aspiration

Prognosis

Dressler syndrome usually is a self limited mild inflammatory illness that resolves. Sometimes Dressler syndrome can recur. Sometimes life threatening tamponade can occur due to pericardial effusion. Less than 1 percent of people with Dressler syndrome with have tamponade. Constrictive inflammation of the pericardium happens in less than 0.5 percent of the time.

People with Dressler syndrome pain can have splinting when breathing. Hypoxemia can occur and oxygen saturation needs to be monitored.

A rare fatal complication of Dressler syndrome is occlusion of a graft in coronary artery bypass surgery. [1, 3]

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What to read next?

Reference List:

1. Emedicine at Medscape, Available from: http://emedicine.medscape.com/article/891471-overview?pa=TmsmOoeNzAT%2FgA26PovFn%2FoDRnT%2Fjc72W75noLOamfAaiecUEoZ2uBtvKGKxhchnfjvIK5IQwcindg376m4UbQ%3D%3D

2. Mayo Clinic, Available from: http://www.mayoclinic.org/diseases-conditions/dresslers-syndrome/basics/definition/con-20026307

3. Patient Info, Available from: http://patient.info/doctor/dresslers-syndrome

4. Wikipedia, Available from: https://en.wikipedia.org/wiki/Dressler_syndrome

5. Clinicalgate.com, Available from: http://clinicalgate.com/pericardial-and-myocardial-disease/

6. Cram.com, Available from: http://www.cram.com/flashcards/pathb2myocardial-2340917

7. Shaw Heart Center, Available from: http://shawheart.com/mitral.php


8. Office of Medical History, Available from: http://history.amedd.army.mil/booksdocs/wwii/thoracicsurgeryvolII/chapter2.htm


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