Dressler Syndrome

Overview

Dressler syndrome is a type of pericarditis, or inflammation of the sac around the heart, that appears weeks after a heart attack, heart surgery, or other injury to the heart. It is now considered one form of the broader post-cardiac injury syndrome.

The condition is thought to be an immune reaction: when heart muscle is damaged, the immune system can mistakenly target the pericardium and nearby tissues, triggering inflammation. Dressler syndrome has become less common as heart attack treatment has improved, but it still occurs. Most cases respond well to anti-inflammatory treatment.

Unlike the chest pain of a heart attack itself, which comes from blocked blood flow to the heart muscle, the discomfort of Dressler syndrome comes from inflammation of the membranes around the heart. This is why the pain often has a different quality, such as being sharp and changing with body position or breathing. Recognizing this delayed pattern helps doctors separate Dressler syndrome from a new heart problem, although any chest pain after a heart attack should still be checked.

Symptoms

Symptoms typically begin a few weeks after the heart event and include:

• Chest pain that is often sharp, worse when lying flat or breathing in, and relieved by sitting forward
• Low-grade fever
• Fatigue and a general unwell feeling
• Shortness of breath
• Fluid buildup around the heart (pericardial effusion) or lungs (pleural effusion)

Because chest pain after a heart attack can have several causes, new or returning chest pain should always be checked by a doctor. People sometimes feel generally unwell and tired during an episode, which can be mistaken for slow recovery from the original heart event. Noticing the combination of low-grade fever with position-related chest pain can help point toward the diagnosis.

Causes

Dressler syndrome is believed to be caused by an immune response to injured heart tissue. Triggers include:

• Heart attack: The classic trigger, with symptoms appearing weeks afterward.
• Heart surgery: Operations involving the heart or pericardium.
• Chest trauma or cardiac procedures: Such as catheter-based interventions.

When heart muscle is damaged, proteins from the injured tissue may prompt the immune system to attack the pericardium, producing delayed inflammation.

Risk Factors

• A recent heart attack, particularly a larger one
• Recent heart surgery or a cardiac procedure
• A previous episode of pericarditis or Dressler syndrome
• A tendency toward inflammatory or autoimmune reactions

Diagnosis

Diagnosis is based on the timing after a heart event plus supporting tests:

• Medical history: Typical symptoms developing weeks after a heart attack or heart surgery.
• Electrocardiogram (ECG): May show changes of pericardial inflammation.
• Echocardiogram: Detects fluid around the heart and checks heart function.
• Blood tests: Often reveal markers of inflammation.
• Chest X-ray: Can show fluid around the heart or lungs.

Treatment

Treatment aims to reduce inflammation and relieve pain:

• Anti-inflammatory medicines: NSAIDs such as aspirin or ibuprofen are commonly used.
• Colchicine: Often added to improve symptoms and reduce the risk of recurrence.
• Corticosteroids: Used for cases that do not respond to other treatments.
• Drainage: If a large effusion strains the heart, fluid may be removed.

Most people recover within a few weeks, though some experience recurrences that need further treatment. Completing the full course of medication, even after the pain settles, helps reduce the chance of the inflammation returning. People who have repeated episodes may need a longer treatment plan guided by a cardiologist, along with monitoring to make sure no significant fluid builds up around the heart.

Prevention

Dressler syndrome cannot always be prevented, but you can manage it well by:

• Attending all follow-up appointments after a heart attack or heart surgery
• Reporting new chest pain, fever, or breathlessness in the weeks afterward
• Taking prescribed anti-inflammatory medication for the full course
• Discussing options to prevent recurrence if you have had it before

When to See a Doctor

See a doctor if you develop chest pain, fever, or shortness of breath in the weeks after a heart attack or heart surgery. Because chest pain can also signal another heart problem, seek emergency care right away if you have:

• Severe, crushing, or spreading chest pain
• Severe shortness of breath
• Fainting or feeling about to pass out
• A racing heartbeat with sweating or weakness

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Dressler syndrome — Symptoms and causes.
2. American Heart Association. What Is Pericarditis?
3. MedlinePlus, U.S. National Library of Medicine. Dressler syndrome.
4. National Heart, Lung, and Blood Institute (NHLBI). Pericarditis.