Dressler's syndrome

Background

Dressler's syndrome, also known as late post-MI pericarditis, is pericarditis that occurs one week to several months after a myocardial infarction. It is thought to be immunologic and is less commonly seen after PE, pericardial trauma, or pericardiectomy.[1]

Clinical Features

Signs and Symptoms
  • Pleuritic chest pain
  • Fever
  • Malaise
  • Pericardial friction rub

Findings

Differential Diagnosis

ST Elevation

Evaluation
  • EKG
  • Labs
    • CBC
    • CRP/ESR
    • Troponin: to rule out concurrent myocarditis
  • Imaging
    • CXR
    • Echocardiogram

Diagnosis
  • Need 2 of the following diagnostic criteria for acute pericarditis[3]
    • Chest pain (typically sharp and pleuritic, improved by sitting up and leaning forward)
    • Pericardial friction rub
    • New or worsening pericardial effusion
    • Suggestive ECG changes

AND

  • Appropriate time-frame: 1 week to approximately 3 months after cardiac injury

Management
  • NSAIDs: There is no evidence that a specific NSAID has increased efficacy, so NSAID choice is typically based on whether there are other indications for an NSAID or likelihood of side effects.
    • Aspirin dosing: 750 to 1000 mg every six to eight hours, with gradual tapering of the total daily dose by 650 to 800 mg every week for a treatment period of three to four weeks
    • Ibuprofen dosing: 600 to 800 mg every six to eight hours, with gradual tapering of the total daily dose by 400 to 800 mg every week for a treatment period of three to four weeks[4]
  • Colchicine: may be used in conjunction with NSAIDs[5]
  • Glucocorticoids: can be used for refractory Dressler's syndrome

Disposition
  • Admission not typically necessary, but should be considered in patients with:
    • Myopericarditis
    • Cardiac tamponade
    • Hemodynamic instability
  • Patients should follow up as an outpatient for repeat inflammatory markers in approximately one month.[6]

See Also


References
  1. Jouriles N. Pericardial and Myocardial Disease. In: Rosen's Emergency Medicine: Concepts and Clinical Practice: Volume 1. Philadelphia: Mosby/Elsevier; 2010.
  2. Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol. 2013;168(2):648–652. doi:10.1016/j.ijcard.2012.09.052
  3. Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015;314(14):1498–506.
  4. Imazio M, Spodick DH, Brucato A, Trinchero R, Adler Y. Controversial issues in the management of pericardial diseases. Circulation. 2010;121(7):916–928. doi:10.1161/CIRCULATIONAHA.108.844753
  5. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921–2964. doi:10.1093/eurheartj/ehv318
  6. Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol. 2013;168(2):648–652. doi:10.1016/j.ijcard.2012.09.052
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