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Postmyocardial Infarction Syndrome / Dressler's Syndrome

Definition:
Dressler's syndrome is a complication that can occur following a heart attack or heart surgery. It occurs when the sac that surrounds your heart (pericardium) becomes inflamed. An immune system reaction is thought to be responsible for Dressler's syndrome, which can develop several days or weeks after heart injury.

Dressler's syndrome causes fever and chest pain, which can feel like another heart attack. Also referred to as postpericardiotomy and postmyocardial infarction syndrome, Dressler's syndrome is easily treated with medications that reduce inflammation.

With recent improvements in the medical treatment of heart attack, Dressler's syndrome is far less common than it used to be. However, once you've had the condition, it's likely to recur, so it's important to be on the lookout for any symptoms of Dressler's syndrome if you've had a heart attack, heart surgery or other heart injury.

Causes:
Dressler's syndrome is thought to develop as an immune system response following a heart attack or heart surgery. Your body's reaction to a heart injury is similar to its reaction to a virus or other illness. It responds to injury and illness by sending proteins called antibodies. The antibodies cause inflammation, and the symptoms of Dressler's syndrome develop.

When to seek medical advice :
Anytime you have fever, chest pain or shortness of breath after a heart attack, surgery or a chest injury (such as from a car accident) call your doctor immediately.

Symptoms:
Dressler's syndrome causes the following signs and symptoms after heart surgery, a heart attack or an injury to your heart:

  • Chest pain
  • Shortness of breath or pain when breathing (pleurisy)
  • Fever
  • Left shoulder pain

Diagnosis:
Your doctor can diagnose Dressler's syndrome from the classic signs and symptoms, listening to your heart and sometimes using blood tests. Other diagnostic tests may also include :

  • Echocardiogram. An echocardiogram uses sound waves to produce an image of your heart. This test allows your doctor to see if swelling is occurring around your heart.
  • Electrocardiogram. An electrocardiogram records the electrical impulses in your heart through wires attached to the skin. Certain changes in the electrical impulses may mean there's pressure on your heart.

Complication :
Two rare but serious complications of Dressler's syndrome are :

  • Cardiac tamponade. This condition occurs when fluid builds up around the heart and presses on it, reducing its ability to pump well. Treatment requires a procedure called pericardiocentesis, in which fluid is removed with a fine needle.
  • Constrictive pericarditis. This condition develops from repeated inflammation of the sac around the heart (pericardium). The inflammation causes the pericardium to become thick and scarred. Treatment requires surgery to remove the pericardium (pericardiectomy).

Other complications include :

  • Pleurisy. This is inflammation of the membranes around your lungs.
  • Pleural effusion. This is a buildup of fluid around your lungs.

Treatment:
Mild cases of Dressler's syndrome may get better on their own without treatment. Your doctor may recommend bed rest until you're feeling better.

More severe cases require medications to reduce the inflammation around your heart. Sometimes hospitalization is necessary.

Medications include :

  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs work by inhibiting an enzyme called cyclooxygenase (COX). This enzyme is responsible for your body's production of prostaglandins, hormone-like substances involved in inflammation and pain.
  • Other pain medications. If your pain is severe, you might need stronger pain medications, such as a narcotic, for a short time.
  • Corticosteroids. These drugs, which include prednisone, mimic the effects of certain hormones in your body, such as cortisone, which are produced by your adrenal glands. When an inflammatory illness strikes, additional cortisone in the form of corticosteroids helps suppress inflammation, which reduces the symptoms of Dressler's syndrome. However, corticosteroids have potential side effects, and there's a risk of rebound inflammation after you stop taking corticosteroids.
  • Colchicine. For resistant cases or for people who have repeated episodes of pericarditis, colchicine is another type of anti-inflammatory medication that has been effective in some cases. It is often used to treat gout.

Hospitalization sometimes necessary
If a complication develops, such as cardiac tamponade, you'll likely need hospitalization When cardiac tamponade occurs, you may undergo a technique called pericardiocentesis. In this procedure, a doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You'll receive a local anesthetic before undergoing pericardiocentesis, which is often done with echocardiogram and ultrasound guidance. This drainage may continue for several days during the course of your hospitalization.

Repeated episodes of Dressler's syndrome can lead to a condition called constrictive pericarditis. If you develop this complication, you may need to undergo a surgical procedure (pericardiectomy) to remove the entire pericardium that has become rigid and is compromising the functioning of your heart.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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