Dressler's syndrome
Template:DiseaseDisorder infobox
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Mohammed A. Sbeih, M.D.[2] Phone:617-849-2629 , Cafer Zorkun, M.D., Ph.D. [3]
Synonyms and keywords: Postmyocardial infarction syndrome, post MI pericarditis
Overview
Dressler's syndrome also has been called post cardiac injury syndrome(PCIS) is a form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart)[1], the Inflammation associated with Dressler's syndrome is believed to be an immune system response following damage to heart tissue or the pericardium. Usually the term dressler's used for the pericarditis that follows the Myocardial Infarction, and usually occurs within weeks or months of the Infarction due to antiheart antibodies, this begins with myocardial injury that releases cardiac antigens and stimulates antibody formation. The immune complexes that are generated then deposit onto the pericardium and causes the inflamation. It is not limited to patients with MI, also occurring in other settings, particularly after cardiac surgery or pulmonary embolism [2]. PCIS was first described after MI by Dressler in 1956[3]. It is usually a late complication, developing weeks to months after the acute MI, but rarely may be evident within the first week post-MI.
Peri-infarct pericarditis (PIP) generally occurring within days of the MI, its a febrile illness secondary to an inflammatory reaction involving pericardium which was more commonly seen in the era prior to reperfusion, but its incidence has markedly decreased in the reperfusion era, presumably because of smaller size of most myocardial infarctions after successful reperfusion therapy. It is more common in patients who have undergone surgery that involves opening the pericardium , its an unusual complication after percutaneous procedures such as coronary stent implantation, after implantation of epicardial pacemaker leads and transvenous pacemaker leads,[4] and following blunt trauma,stab wounds, and heart puncture.[5] Various viral agents, including coxsackie B, adenovirus, and cytomegalovirus, have been present in approximately two thirds of patients with postpericardiotomy syndrome, suggesting an autoimmune response associated with a viral infection.[6][7]
Historical Perspective
It was first characterized by William Dressler in 1956.[8][9][10]
It should not be confused with the Dressler's syndrome of haemoglobinuria named for Lucas Dressler, who characterized it in 1854.[11][12]
Risk Factors
Dressler's syndrome is associated with myocardial infarction (heart attack), and with open heart surgery.
Pathophysiology
Dressler's syndrome is believed to result from an autoimmune inflammatory reaction to myocardial neo-antigens.
Epidemiology and Demographics
In the setting of myocardial infarction, Dressler's syndrome occurs in about 7% of cases[13].
Conditions that Dressler's Syndrome should be Differentiated From
Dressler's syndrome typically occurs 2 to 10 weeks after a myocardial infarction has occurred[14]. 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.
Diagnosis
Symptoms
The syndrome consists of a persistent low-grade fever, and chest pain which is usually pleuritic in nature. The symptoms tend to occur after a few weeks or even months after myocardial infarction and tend to subside in a few days.
Physical Examination
Cardiovascular Examination
A pericardial friction rub, and /or a pericardial effusion is present.
Laboratory Findings
Elevated ESR.
Treatment
Dressler's syndrome is typically treated with NSAIDs such as aspirin or with corticosteroids.[15]
ACC/AHA Guidelines (DO NOT EDIT)[16]
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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) |
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Sources
- The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [16]
- The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [17]
References
- ↑ Hutchcroft BJ (1972). "Dressler's syndrome". Br Med J. 3 (5817): 49. PMC 1788531. PMID 5039567. Unknown parameter
|month=ignored (help) - ↑ Jerjes-Sánchez C, Ramírez-Rivera A, Ibarra-Pérez C (1996). "The Dressler syndrome after pulmonary embolism". Am J Cardiol. 78 (3): 343–5. PMID 8759817.
- ↑ DRESSLER W (1956). "A post-myocardial infarction syndrome; preliminary report of a complication resembling idiopathic, recurrent, benign pericarditis". J Am Med Assoc. 160 (16): 1379–83. PMID 13306560.
- ↑ Goutal H, Baur F, Bonnevie L, Monnier G, Le Blainvaux M, Brion R (1995). "[Postpericardiotomy syndrome; a rare complication of transcavitary cardiac pacing: apropos of a case]". Arch Mal Coeur Vaiss. 88 (12): 1901–3. PMID 8729373.
- ↑ Peter RH, Whalen RE, Orgain ES, McIntosh HD (1966). "Postpericardiotomy syndrome as a complication of percutaneous left ventricular puncture". Am J Cardiol. 17 (1): 86–90. PMID 5900343.
- ↑ Andreev DA, Giliarov MIu, Syrkin AL, Udovichenko AE, Gerok DV (2008). "[Postcardiotomy syndrome outside a cardiosurgical clinic]". Klin Med (Mosk). 86 (10): 67–71. PMID 19069464.
- ↑ Hazelrigg SR, Mack MJ, Landreneau RJ, Acuff TE, Seifert PE, Auer JE (1993). "Thoracoscopic pericardiectomy for effusive pericardial disease". Ann Thorac Surg. 56 (3): 792–5. PMID 8379795.
- ↑ 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.
- ↑ 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.
- ↑ 16.0 16.1 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)