Dressler syndrome (post-myocardial infarction syndrome)

Definition

Dressler syndrome (post-myocardial infarction syndrome) is a delayed, autoimmune-mediated inflammation of the pericardium and pleura after a myocardial infarction. Together with postpericardiotomy syndrome and traumatic pericarditis it forms the group of post-cardiac injury syndromes.

It is distinguished from early post-infarction pericarditis, which develops shortly after an infarction directly over the necrosis.

Occurrence & epidemiology

Dressler syndrome has become rare. Its frequency has decreased markedly with early reopening of occluded coronary arteries; some authors consider it to have almost vanished in the current era. Early post-infarction pericarditis is more common and affected about 1–2 % of patients with infarction in one cohort.

Aetiopathogenesis

The cause is an autoimmune reaction to material from necrotic myocytes. The released antigens lead to immune-mediated inflammation of the pericardium, pleura and sometimes the lungs.

Clinical features

The syndrome begins days to weeks, occasionally months, after the infarction, typically later than one week.

• fever and general malaise
• pericarditis with friction rub and pericardial effusion; the pain worsens with breathing, coughing and movement and is relieved by sitting up and leaning forward
• pleuritis with pleural effusions, pulmonary infiltrates, joint pain
• The syndrome may recur.

Diagnosis

• Clinical diagnosis based on symptoms and timing relative to the infarction. For acute pericarditis the classic rule is at least 2 of 4 features (characteristic chest pain, pericardial friction rub, ECG changes, pericardial effusion).
• Distinction from extension or recurrence of infarction: in Dressler syndrome cardiac troponin does not increase significantly and ECG changes are nonspecific.
• ECG in pericarditis: diffuse PR depression and/or ST elevation without reciprocal ST depression (except aVR and V1) and without pathological Q waves.
• Laboratory tests: elevated inflammatory markers (CRP, ESR).
• Imaging: echocardiography to detect pericardial effusion; chest X-ray showing pleural effusions or infiltrates.

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Further reading (open access)

1. MSD Manual Professional: Complications of Acute Coronary Syndromes
2. MSD Manual Professional: Pericarditis
3. StatPearls: Dressler Syndrome

Cross-references