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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor= {{YD}} (Reviewed by  {{YD}})
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Cardiology
|SubCategory=Cardiology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Cardiology
|SubCategory=Cardiology
|Prompt=A 63 year old male patient presents to the emergency department with severe chest pain and dyspnea. Following rapid work-up, the diagnosis of myocardial infarction (MI) is made. The patient undergoes appropriate management and is discharged home. The patient returns 5 weeks later to the emergency department with complains of a new-onset low grade fever and chest pain that radiates to the back and is relieved when leaning forward. Cardiac auscultation shows friction rub. Which of the following pathologic processes is responsible for this patient’s new condition?
|Prompt=A 63-year-old man presents to the emergency department with severe chest pain and dyspnea. Following rapid work-up, the diagnosis of myocardial infarction (MI) is made. The patient undergoes appropriate management and is then discharged home. The patient returns 5 weeks later to the emergency department with complaints of a new-onset, low-grade fever associated with persistent chest pain that radiates to the back and relieved by leaning forward. Cardiac auscultation is remarkable for friction rub. Which of the following pathological processes is responsible for this patient’s rehospitalization?
|Explanation=[[Dressler’s syndrome]] is an [[autoimmune]] process that occurs 4-6 weeks after [[MI]]. It results in [[fibrinous pericarditis]] and causes symptoms of low-grade fever and characteristic pericarditis-induced chest pain that is classically described as radiating to the back and is relieved by leaning forward. Patients typically have signs of [[pericarditis]] on physical examination, such as pericardial [[friction rub]].
|Explanation=[[Dressler syndrome]] (post-myocardial infarction syndrome) is an [[autoimmune]] fibrinous pericarditis that occurs 4-6 weeks following a [[myocardial infarction]] (MI) (typically large infarct size in the anterior region). It is characterized by delayed onset of symptoms post-MI, presence of antiheart antibodies, change in cellular immunity, high recurrence rate, and rapid response to anti-inflammatory agents, all of which confirm the autoimmune nature of the disease. Dressler syndrome manifests with low-grade fever and characteristic pericarditis-induced chest pain that is classically described as chest pain that radiates to the back and relieved by leaning forward. On physical examination, patients typically have signs of [[pericarditis]] (pericardial [[friction rub]]). Dressler syndrome is typically managed with administration of aspirin. Dressler syndrome is distinguished from other forms of post-MI pericarditis (epistenocardiac pericarditis) by its autoimmune nature, association with more severe symptoms, significant elevations in ESR, and delayed onset post-MI.
 
Educational Objective:
Dressler’s syndrome is an autoimmune fibrinous pericarditis that typically occurs 4-6 weeks after MI.
 
|AnswerA=Increased left ventricular (LV) preload due to left ventricular failure post-MI
|AnswerA=Increased left ventricular (LV) preload due to left ventricular failure post-MI
|AnswerAExp=LV failure is a complication of MI, but the symptoms and signs of the patient in the vignette do not suggest LV failure.
|AnswerAExp=LV failure is a common complication post-MI, but the symptoms and signs of this patient do not suggest LV failure.
|AnswerB=Ventricular free wall rupture with subsequent fluid accumulation in the pericardial sac
|AnswerB=Ventricular free wall rupture with subsequent fluid accumulation in the pericardial sac
|AnswerBExp=Ventricular free wall rupture and subsequent cardiac tamponade are life-threatening emergencies. Symptoms of cardiac tamponade are chest pain, hypotension, jugular venous distension, and pulsus paradoxus.
|AnswerBExp=Ventricular free wall rupture and subsequent cardiac tamponade are life-threatening emergencies. Manifestations of cardiac tamponade include dyspnea, chest pain, hypotension, jugular venous distension, pulsus paradoxus, and faint heart sounds upon auscultation.
|AnswerC=New onset cardiac arrhythmia that abolishes the atrial kick
|AnswerC=New-onset cardiac arrhythmia that abolishes the atrial kick
|AnswerCExp=Cardiac arrhythmias could result post-MI but their presentation would not be like that in the vignette.
|AnswerCExp=Cardiac arrhythmias are common post-MI complications, but the patient's signs and symptoms are not suggestive of cardiac arrhythmias.
|AnswerD=Autoimmune process that causes fibrinous disease
|AnswerD=Autoimmune process that causes fibrinous pericarditis
|AnswerDExp=Dressler’s syndrome is an autoimmune process that causes fibrinous pericarditis.
|AnswerDExp=Dressler syndrome is an autoimmune process that causes fibrinous pericarditis.
|AnswerE=Post-procedural stent thrombosis
|AnswerE=Post-procedural stent thrombosis
|AnswerEExp=Post-procedural stent thrombosis is a complication of percutaneous interventions (PCI). Symptoms and signs would not be similar to the patient in the vignette that are strongly suggestive of a pericardial disease rather than a coronary disease.
|AnswerEExp=Post-procedural stent thrombosis is a complication of percutaneous interventions (PCI). The patient's symptoms and signs are strongly suggestive of a pericardial disease rather than a coronary disease.
|EducationalObjectives=Dressler syndrome is an autoimmune fibrinous pericarditis that typically occurs 4-6 weeks following a myocardial infarction.
|References=Spodick DH. Decreased recognition of the post-myocardial infarction (Dressler) syndrome in the postinfarct setting: Does it masquerade as "idiopathic pericarditis" following silent infarcts? Chest. 2004;126(5):1410-1.<br>
First Aid 2014 page 288, 289, 293
|RightAnswer=D
|RightAnswer=D
|WBRKeyword=Dressler's, syndrome, myocardial, infarction, pericarditis, fibrinous, chest, pain, autoimmune
|WBRKeyword=Dressler syndrome, Myocardial infarction, Pericarditis, Chest pain, Autoimmune disease, Fibrinous pericaraditis, Complication, Post-myocardial infarction syndrome
|Approved=No
|Approved=No
}}
}}

Latest revision as of 00:32, 28 October 2020

 
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Cardiology
Prompt [[Prompt::A 63-year-old man presents to the emergency department with severe chest pain and dyspnea. Following rapid work-up, the diagnosis of myocardial infarction (MI) is made. The patient undergoes appropriate management and is then discharged home. The patient returns 5 weeks later to the emergency department with complaints of a new-onset, low-grade fever associated with persistent chest pain that radiates to the back and relieved by leaning forward. Cardiac auscultation is remarkable for friction rub. Which of the following pathological processes is responsible for this patient’s rehospitalization?]]
Answer A AnswerA::Increased left ventricular (LV) preload due to left ventricular failure post-MI
Answer A Explanation AnswerAExp::LV failure is a common complication post-MI, but the symptoms and signs of this patient do not suggest LV failure.
Answer B AnswerB::Ventricular free wall rupture with subsequent fluid accumulation in the pericardial sac
Answer B Explanation [[AnswerBExp::Ventricular free wall rupture and subsequent cardiac tamponade are life-threatening emergencies. Manifestations of cardiac tamponade include dyspnea, chest pain, hypotension, jugular venous distension, pulsus paradoxus, and faint heart sounds upon auscultation.]]
Answer C AnswerC::New-onset cardiac arrhythmia that abolishes the atrial kick
Answer C Explanation AnswerCExp::Cardiac arrhythmias are common post-MI complications, but the patient's signs and symptoms are not suggestive of cardiac arrhythmias.
Answer D AnswerD::Autoimmune process that causes fibrinous pericarditis
Answer D Explanation AnswerDExp::Dressler syndrome is an autoimmune process that causes fibrinous pericarditis.
Answer E AnswerE::Post-procedural stent thrombosis
Answer E Explanation AnswerEExp::Post-procedural stent thrombosis is a complication of percutaneous interventions (PCI). The patient's symptoms and signs are strongly suggestive of a pericardial disease rather than a coronary disease.
Right Answer RightAnswer::D
Explanation [[Explanation::Dressler syndrome (post-myocardial infarction syndrome) is an autoimmune fibrinous pericarditis that occurs 4-6 weeks following a myocardial infarction (MI) (typically large infarct size in the anterior region). It is characterized by delayed onset of symptoms post-MI, presence of antiheart antibodies, change in cellular immunity, high recurrence rate, and rapid response to anti-inflammatory agents, all of which confirm the autoimmune nature of the disease. Dressler syndrome manifests with low-grade fever and characteristic pericarditis-induced chest pain that is classically described as chest pain that radiates to the back and relieved by leaning forward. On physical examination, patients typically have signs of pericarditis (pericardial friction rub). Dressler syndrome is typically managed with administration of aspirin. Dressler syndrome is distinguished from other forms of post-MI pericarditis (epistenocardiac pericarditis) by its autoimmune nature, association with more severe symptoms, significant elevations in ESR, and delayed onset post-MI.

Educational Objective: Dressler syndrome is an autoimmune fibrinous pericarditis that typically occurs 4-6 weeks following a myocardial infarction.
References: Spodick DH. Decreased recognition of the post-myocardial infarction (Dressler) syndrome in the postinfarct setting: Does it masquerade as "idiopathic pericarditis" following silent infarcts? Chest. 2004;126(5):1410-1.
First Aid 2014 page 288, 289, 293]]

Approved Approved::No
Keyword WBRKeyword::Dressler syndrome, WBRKeyword::Myocardial infarction, WBRKeyword::Pericarditis, WBRKeyword::Chest pain, WBRKeyword::Autoimmune disease, WBRKeyword::Fibrinous pericaraditis, WBRKeyword::Complication, WBRKeyword::Post-myocardial infarction syndrome
Linked Question Linked::
Order in Linked Questions LinkedOrder::