Dressler Syndrome

What causes Dressler syndrome

When heart muscle or the pericardium is damaged, proteins from injured cells are released. In some people, the immune system reacts to these proteins and attacks the pericardium, causing inflammation. The same process can follow:

• a heart attack, especially a large one
• open-heart surgery (where it is called postpericardiotomy syndrome)
• pacemaker or defibrillator lead placement
• catheter ablation or other heart procedures
• chest trauma

These are grouped together as post-cardiac injury syndrome.

Dressler syndrome after heart attacks has become much less common since doctors started opening blocked arteries quickly with stents or clot-busting drugs, which limits heart damage. Postpericardiotomy syndrome after heart surgery is still relatively common.

Symptoms

Symptoms typically start 1 to 6 weeks after the heart injury, but can appear earlier or months later.

• Chest pain: sharp or stabbing, often behind the breastbone, worse when lying flat, breathing in deeply or coughing, and eased by sitting up and leaning forward
• fever, usually low grade
• fatigue and feeling unwell
• shortness of breath
• pain in the shoulder or neck
• a dry cough or pain on breathing if the lung lining is also inflamed (pleurisy)

How it differs from a second heart attack

Because the two can be hard to tell apart, any chest pain after a heart attack needs prompt medical assessment.

Diagnosis

• Examination: a doctor may hear a scratching sound (pericardial friction rub) with a stethoscope.
• ECG: shows patterns typical of pericarditis.
• Echocardiogram: ultrasound of the heart shows fluid around the heart (pericardial effusion) and checks heart function.
• Blood tests: inflammation markers (CRP, ESR) and white blood cell count are raised. Troponin helps rule out a new heart attack.
• Chest X-ray: may show fluid around the lungs or an enlarged heart outline.
• Cardiac MRI or CT in uncertain cases.

Treatment

• Anti-inflammatory medicine: high-dose aspirin is preferred after a heart attack. Other NSAIDs such as ibuprofen may be used after heart surgery or once the heart attack is no longer recent, as advised by a cardiologist. These are taken for 1 to 2 weeks, then tapered.
• Colchicine: reduces symptoms and lowers the risk of recurrence. Usually continued for about 3 months.
• Steroids: used if other treatments fail or cannot be taken, but they may increase the chance of recurrence and slow heart healing, so they are not first choice.
• Pericardiocentesis: draining fluid with a needle if a large effusion is pressing on the heart.
• Rest: avoid strenuous exercise until symptoms and inflammation markers settle.

Never stop prescribed heart medicines, such as blood thinners, without speaking to your cardiologist.

Complications

• Cardiac tamponade: fluid squeezing the heart, an emergency.
• Recurrent pericarditis: returns in a minority of people.
• Constrictive pericarditis: rarely, long-term scarring stiffens the pericardium and restricts the heart.

Outlook

Most people recover fully within a few weeks of treatment. Recurrences can happen but usually respond to treatment again, especially with colchicine.

Frequently asked questions

What is Dressler syndrome?

Dressler syndrome is inflammation of the sac around the heart that develops weeks after a heart attack, heart surgery or other heart injury. It is believed to be an immune reaction to damaged heart tissue and causes sharp chest pain, fever and fatigue.

How soon after a heart attack does Dressler syndrome occur?

It usually starts 1 to 6 weeks after a heart attack or heart surgery, although it can appear earlier or, occasionally, months later. It has become uncommon after heart attacks since the widespread use of stents and clot-busting treatment.

How is Dressler syndrome treated?

Treatment usually combines high-dose aspirin or another anti-inflammatory with colchicine. Steroids are used if these do not work. If a large amount of fluid collects around the heart, it may be drained with a needle.

Is Dressler syndrome serious?

Most cases are mild and settle with treatment within weeks. It can be serious if a large amount of fluid builds up and squeezes the heart, which needs emergency drainage. Rarely, it leads to recurrent or constrictive pericarditis.