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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
- Clinical Presentation - Symptoms and timing after MI are crucial.
- Electrocardiogram (ECG) - May show widespread ST-segment elevation.
- Echocardiography - To detect pericardial effusion.
- 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
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
- https://academic.oup.com/eurheartj/article/36/42/2921/2293375
- https://pubmed.ncbi.nlm.nih.gov/26320112/
- 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
- https://pubmed.ncbi.nlm.nih.gov/15120056/
2. American Heart Association Guidelines on Pericardial Diseases
- https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514
- https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis
- https://www.sciencedirect.com/science/article/abs/pii/S1936878X24001608
- https://www.jacc.org/doi/10.1016/j.jacc.2019.11.021
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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