Dressler's Syndrome Treatment- Cardiology

Dressler's syndrome, also known as Postmyocardial Syndrome, is a type of secondary pericarditis, an inflammation of the pericardium, the tough elastic sac that surrounds your heart. This may occur due to your immune system's reaction to cardiac injury.

When your pericardium becomes inflamed, it might press on your heart, causing pain in the chest. Excess fluid can also accumulate between the two layers of your pericardium. This puts strain on your heart.

Dressler's syndrome can occur due to a heart attack (myocardial infarction), a heart treatment (percutaneous coronary or intracardiac interventions, pacemaker lead insertion, radiofrequency ablation), cardiac surgery, or chest trauma caused by an injury or an accident. If left untreated, pericardial inflammation can cause scarring, thickening, and muscular tightening of the heart, which can be fatal. Dressler’s syndrome is treated with high doses of aspirin or other anti-inflammatory drugs.

Symptoms and Diagnosis

Early recognition and diagnosis of Dressler syndrome are crucial for prompt treatment and management. Here, we will look into the symptoms and diagnostic methods associated with this condition.

Symptoms:

• Chest Pain: One of the major symptoms of Dressler syndrome is chest pain. It is typically sharp and pleuritic with a range of intensities, worsening with deep breaths or movement. This chest pain may be similar to the pain that happens initially during a heart attack but tends to occur after the acute phase.
• Fever: Patients with Dressler syndrome often experience an unexplained fever, which is one of the key indicators of ongoing inflammation in the pericardium. The fever can range from low grade to high grade.
• Pericardial Friction Rub: A characteristic clinical sign of Dressler syndrome is the presence of a pericardial friction rub, which can be heard during a physical examination. This rubbing or scratching sound occurs as the inflamed pericardial layers rub against each other with each heartbeat.
• Shortness of Breath:Excess buildup of fluid in the pericardial sac surrounding the heart (pericardial effusion) compresses the heart chambers. Breathing difficulties may come from this, especially when reclining or resting flat (orthopnea).
• Malaise and Fatigue: Patients with Dressler syndrome often report a general feeling of unwellness, along with fatigue and weakness. These symptoms are often non-specific but can be indicative of the underlying inflammation.

Diagnosis:

Diagnosing Dressler syndrome can be challenging due to the similarity of its symptoms to other cardiac and respiratory conditions. Healthcare providers typically employ a combination of clinical evaluation, imaging studies, and laboratory tests to arrive at a definitive diagnosis:

• Medical History and Physical Examination: The patient's medical history, including any recent heart-related events or surgeries, is crucial in assessing the likelihood of Dressler syndrome. During the physical examination, the presence of a pericardial friction rub and other clinical signs is assessed.
• Blood Tests: Laboratory tests, including complete blood count (CBC) and inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), may show elevated levels, indicating inflammation.
• Imaging: Imaging studies, such as echocardiography and chest X-rays, can help visualize pericardial effusion, which is a common finding in Dressler syndrome. Echocardiography can also assess cardiac function and rule out other cardiac complications.
• Electrocardiogram (ECG or EKG): An ECG may be performed to assess changes in heart rhythm and electrical activity, which can help differentiate Dressler syndrome from other cardiac issues.
• CT or MRI: To see the pericardium and surrounding structures in greater detail, computed tomography (CT) or magnetic resonance imaging (MRI) may be done. .
• Pericardiocentesis: If there is a large pericardial effusion or clinical suspicion of cardiac tamponade, a pericardiocentesis (draining of the pericardial fluid) may be necessary both for diagnosis and therapeutic purposes.

Why Is Dressler's Syndrome Treatment Necessary?

Inflammation of the pericardium can lead to significant problems if left untreated. The immunological response that causes Dressler’s syndrome may also result in pleural effusion. This happens when fluid builds up in the membranes around your lungs.

In rare situations, chronic inflammation in the heart can lead to life-threatening consequences such as Cardiac Tamponade. This occurs when fluids accumulate in the sac around the heart. The fluid strains the heart, preventing it from pumping enough blood to the rest of the body. This can result in organ failure, shock, and death.

Chronic cardiac inflammation can also result in constrictive pericarditis. This occurs when the pericardium thickens or scars due to chronic inflammation.

Because Dressler's syndrome symptoms can be fatal, it is critical to seek medical attention if you have chest pain and difficulty breathing, especially if you have previously been hospitalized for cardiac problems.

Which Doctor To Consult?

Speak with a cardiologist about the procedure, the risks, and the aftercare. Seek immediate attention if you experience sudden or persistent chest pain, which could indicate a heart attack or another serious condition.

What To Expect During Dressler's Syndrome Treatment?

Dressler's syndrome can be treated with medications prescribed by your cardiologist. Anti-inflammatory medications can help you manage your pain and inflammation. Aspirin or other nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen or naproxen are typically used as the primary treatment.

Your provider is likely to use one of the following dosage schedules:

• Ibuprofen (600-800 mg every six to eight hours).
• Aspirin at a high dose (750 to 1,000 mg every six to eight hours).

As your pericarditis symptoms improve, you will take less medication each week. You will have to take the prescription for four to six weeks.

If you are unable to take aspirin or NSAIDs, or if they are no longer effective, your provider may prescribe:

• Prednisone, which is a kind of steroid.
• Colchicine (Colcrys® or Gloperba®).

If medications do not help, you may need surgery. Other treatment options may be considered if complications arise. 

Pleural effusion is treated using a needle to drain the fluid from the lungs. This procedure is medically called Thoracentesis.

Pericardiocentesis is a treatment used to treat Cardiac Tamponade. A needle or catheter is used to drain extra fluid during this treatment. Complications from pericardiocentesis range from 4% to 20%, with serious ones occurring 1% to 2% of the time.

A pericardiocentesis can result in the following complications:

• A collapsed lung.
• Damage to your heart or another organ nearby.
• Cardiac arrest.
• Arrhythmias (Abnormal rhythm of the heart).
• Bleeding.

Pericardiectomy (removal of the pericardium) may be used to treat constrictive pericarditis.

Complications

Complications from Dressler's syndrome might be fatal in rare cases. As a result, it is critical to seek immediate diagnosis and treatment.

The following are examples of rare complications:

Constrictive pericarditis: Constrictive pericarditis is a disorder in which the pericardium stiffens and thickens. This affects your heart's ability to pump blood and can cause serious problems, including heart failure.

Cardiac Tamponade: Cardiac Tamponade occurs when the fluid sac surrounding your heart becomes overfilled with blood or other fluid, putting pressure on your heart. This stops your heart's chambers from filling adequately.

When your heart fails to fill adequately with blood, it cannot pump as much, and your blood pressure drops. As a result, your heart may beat faster (more than 100 beats/min) to try to pump more blood.

References:

• Leib AD, Foris LA, Nguyen T, et al. Dressler Syndrome. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441988/
• Beaufils, P et al. “Syndrome de Dressler: Péricardite constrictive post-infarctus opérée avec succès” [Dressler's syndrome: constrictive pericarditis following myocardial infarction operated on with success]. Archives des maladies du coeur et des vaisseaux vol. 68,6 (1975): 651-6.
• https://my.clevelandclinic.org/health/diseases/21906-cardiac-tamponade

Disclaimer: Please note that Mya Care does not provide medical advice, diagnosis, or treatment. The information provided is not intended to replace the care or advice of a qualified health care professional. The views expressed are personal views of the author and do not necessarily reflect the opinion of Mya Care. Always consult your doctor for all diagnoses, treatments, and cures for any diseases or conditions, as well as before changing your health care regimen. Do not reproduce, copy, reformat, publish, distribute, upload, post, transmit, transfer in any manner or sell any of the materials on this page without the prior written permission from myacare.com.