Dressler syndrome

Dressler syndrome (DS) is a delayed immune-mediated or secondary pericarditis developing weeks to months after a myocardial infarction (MI).

Terminology

Dressler syndrome is not to be confused with pericarditis epistenocardica (which is seen earlier in the post-MI period) and is considered a rare phenomenon in the era of reperfusion (nowadays percutaneous coronary intervention [PCI]).

Epidemiology

Once described as occurring in 1-5% of MIs, the incidence has decreased owing to reperfusion (initially thrombolysis and following PCI) and may well be below 0.5% .

Clinical presentation

Patients typically present from one week to a few months after large myocardial infarction.

Typical symptoms include:

• pleuritic chest pain
• fever
• general malaise

Typical signs comprise:

• leukocytosis and raised inflammatory markers
• pericardial friction rub (murmurs by auscultation)

It is common for pericardial effusion to develop but tamponade is rare.

Pathology

The etiology is not well understood, and several possible pathomechanisms have been proposed, including local inflammation, autoimmune response, and latent viruses. There is a consensus that :

• Dressler syndrome shares similarities with other entities seen after myocardial damage, including
  • postcardiotomy syndrome
  • posttraumatic pericarditis
• Dressler syndrome is most likely immunomodulated

It is most commonly seen after transmural infarction; however, it may also be seen in milder forms of myocardial infarction .

Radiographic features

Plain radiograph

• may show nonspecific cardiac enlargement
• see also the main article on pericarditis
• there may be co-existing pleural effusion

CT

• may reveal pericardial effusion of varying size, may be simple (serous) or more often complex, e.g. hemopericardium 
• myocardial thinning of the infarcted region and possibly stents in the coronary arteries (status post PCI) may be present

MRI

ECG-gated MR (cardiac MR or CMR) is the imaging modality of choice . Findings comprise:

• intense late post-gadolinium enhancement of entire pericardium
• typically regional thinning and akinesis of the infarcted myocardium ( a complication of transmural infarction)

Treatment and prognosis

The clinical course is most often benign. Conservative management includes NSAIDs and colchicine. However, tamponade and free wall rupture may occur, necessitating urgent surgery. Constrictive pericarditis may be a rarely associated complication. Pericardiocentesis with fibrin-glue instillation may be tried .

History and etymology

It is named after cardiologist William Dressler (1890-1969), who discovered it in the late 1950s .

Differential diagnosis

• see main article for pericarditis

Siehe auch:

• Perikarditis
• Pericarditis epistenocardica
• Postmyokardiotomie-Syndrom