Dressler's Pericarditis

Introduction

Dressler's pericarditis, also called post-myocardial infarction syndrome, is a type of pericarditis that occurs after a heart attack (myocardial infarction) or heart surgery. It is an autoimmune response where the body's immune system mistakenly attacks the pericardium—the sac surrounding the heart—causing inflammation.

Causes and Pathophysiology

  • Usually develops weeks to months after a myocardial infarction (heart attack), heart surgery, or cardiac trauma.
  • It results from an autoimmune reaction where the body produces antibodies against heart tissue due to myocardial damage.
  • Leads to pericardial inflammation, sometimes associated with pleural effusions (fluid around the lungs) and fever.

Symptoms

  • Chest pain (worse with deep breathing and lying flat, relieved by sitting up)
  • Fever
  • Pericardial friction rub (a scratching heart sound heard on auscultation)
  • Fatigue
  • Shortness of breath

Diagnosis

  1. Clinical Presentation - Symptoms and timing after MI are crucial.
  2. Electrocardiogram (ECG) - May show widespread ST-segment elevation.
  3. Echocardiography - To detect pericardial effusion.
  4. Inflammatory Markers - Elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Treatment

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) (e.g., ibuprofen, aspirin) - First-line treatment for pain and inflammation.
  • Colchicine - Can be used to prevent recurrence.
  • Corticosteroids - Used in refractory cases but should be avoided if possible due to the risk of delayed myocardial healing.
  • Pericardiocentesis - If a large effusion develops, fluid drainage may be needed.

Prognosis

Most patients recover well with appropriate treatment, but recurrence can occur in some cases.

Prevention

  • Prompt and complete myocardial infarction treatment
  • Early use of NSAIDs and colchicine when at risk

Summary

Dressler’s pericarditis is a delayed inflammatory response after a heart attack or surgery. Recognition and appropriate treatment help in reducing complications and improving outcomes.

Source recommendations

1. European Society of Cardiology Guidelines on Pericardial Diseases

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
  2. https://academic.oup.com/eurheartj/article/36/42/2921/2293375
  3. https://pubmed.ncbi.nlm.nih.gov/26320112/
  4. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2015/10/30/12/01/2015-esc-guidelines-for-the-diagnosis-and-management-of-pericardial-diseases
  5. https://pubmed.ncbi.nlm.nih.gov/15120056/

2. American Heart Association Guidelines on Pericardial Diseases

  1. https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514
  2. https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis
  3. https://www.sciencedirect.com/science/article/abs/pii/S1936878X24001608
  4. https://www.jacc.org/doi/10.1016/j.jacc.2019.11.021
  5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of

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