Dressler's syndrome (patient information)
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Dressler's syndrome |
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Dressler's syndrome On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pericarditis is inflammation and swelling of the covering of the heart (pericardium). The condition can occur in the days or weeks following a heart attack.
What are the symptoms of Dressler's syndrome?
- Anxiety
- Chest pain
- May come and go (recur)
- Pain may be sharp and stabbing (pleuritic) or tight and crushing (ischemic)
- Pain may get worse when breathing and may go away when you stand or sit up
- Pain moves to the neck, shoulder, back, or abdomen
- Difficulty breathing
- Dry cough
- Fast heart rate (tachycardia)
- Fatigue
- Fever (more common with the second type of pericarditis)
- Malaise (general ill feeling)
- Splinting of ribs (bending over or holding the chest) with deep breathing
What causes Dressler's syndrome?
- Two types of pericarditis can occur after a heart attack.
- The first type of pericarditis most often occurs within 2 to 5 days after a heart attack. When the body tries to clean up the diseased heart tissue, swelling and inflammation occur.
- The second type of pericarditis is also called Dressler's syndrome (or post-cardiac injury syndrome or postcardiotomy pericarditis). It occurs several weeks or months after a heart attack, heart surgery, or other trauma to the heart. Dressler's syndrome is believed to be caused by the immune system attacking the area.
- Pain occurs when the pericardium becomes inflamed (swollen) and rubs on the heart.
Who is at highest risk?
When to seek urgent medical care?
Call your health care provider if:
You develop symptoms of pericarditis after a heart attack You have been diagnosed with pericarditis and symptoms continue or come back, despite treatment
Diagnosis
The health care provider will use a stethoscope to listen to your heart and lungs. There may be a rubbing sound (called a pericardial friction rub, not to be confused with a heart murmur). Heart sounds in general may be weak or sound far away. A buildup of fluid in the covering of the heart or space around the lungs (pericardial effusion) is not common after a heart attack. But, it often does occur in some patients with Dressler's syndrome. Tests may include:
- Cardiac injury markers (CK-MB and troponin may help tell pericarditis from a heart attack)
- Chest CT scan
- Chest MRI
- Chest x-ray
- Complete blood count
- ECG
- Echocardiogram
- ESR (sedimentation rate) or C-reactive protein (measures of inflammation)
Treatment options
The goal of treatment is to make the heart work better and reduce pain and other symptoms.
- Nonsteroidal anti-inflammatory medications (NSAIDs) or aspirin may be used to treat inflammation of the pericardium. Usually aspirin, even in high doses, is preferred in early post-MI pericarditis. In extreme cases, when other medicines don't work, steroids or colchicine may be used.
- In some cases, excess fluid surrounding the heart (pericardial effusion) may need to be removed. This is done with a procedure called pericardiocentesis. If complications develop, part of the pericardium may need to be removed with surgery (pericardiectomy).
Where to find medical care for Dressler's syndrome?
What to expect (Outlook/Prognosis)?
The condition may come back, even in people who receive treatment. In some cases, untreated pericarditis can be life threatening.