Dressler Syndrome

Inflammation of the sac around the heart is known as Dressler syndrome (pericarditis). It's thought to happen as a result of the immune system reacting to injury to the heart's tissue or the sac surrounding it (pericardium). A heart attack, surgery, or acute accident can all cause damage. Chest discomfort is one of the symptoms and it might feel like a heart attack.

Dressler syndrome is sometimes referred to as post-pericardiotomy syndrome, post-pericardial infarction syndrome, post-traumatic pericarditis, and post-cardiac injury syndrome.

Dressler syndrome should be taken into consideration in all patients who come with prolonged lethargy or malaise after a myocardial infarction (MI) or cardiac surgery, even though it is a rare illness, particularly if symptoms appear more than two weeks after the incident.

Dressler Syndrome: Causes

Inflammation of the pericardium, a fibroelastic sac that surrounds the heart and is made up of parietal and visceral layers separated by a potential gap, is known as pericarditis. The pericardial cavity normally contains 15 to 50 mL of pericardial fluid (an ultrafiltrate of plasma).

The post-cardiac injury disorders that contain Dressler syndrome are as follows −

• Syndrome after pericardiotomy

• Post-traumatic pericarditis caused by iatrogenic factors, such as percutaneous coronary or intracardiac procedures, in cases of blunt or penetrating trauma

• Inserting pacemaker leads and radiofrequency ablation

Each one represents a distinct clinical condition characterized by an initial injury to the heart's pericardium, myocardium, or pleura, followed by an inflammatory syndrome that can range from a straightforward case of pericarditis to one with pleuropericarditis, cardiac tamponade, or a significant pleural effusion.

Although the exact cause of Dressler syndrome is unknown, it is assumed that the condition is caused by an immune response being triggered by an initial injury to mesothelial pericardial cells combined with blood in the pericardial space, which leads to an immune complex deposition in the pericardium, pleura, and lungs and an inflammatory response.

Dressler Syndrome: Symptoms

After a heart attack, surgery, or injury to the chest, symptoms are likely to start showing up weeks to months later. Some signs might be −

• Heartache 

• Fever

Dressler syndrome's immune system reaction may also result in fluid accumulation in the tissues around the lungs (pleural effusion).

Occasionally, major consequences from Dressler syndrome might include −

• Heart blockage. An accumulation of fluid in the sac may result from pericardial inflammation (pericardial effusion). The fluid may exert pressure on the heart, making it work harder and less effectively to pump blood. 

• Pericarditis with constriction. The pericardium may develop scarring or thicken as a result of persistent or recurrent inflammation. The scarring may make the heart less capable of pumping blood.

Although the exact cause of Dressler syndrome is unknown, it is assumed that the condition is caused by an immune response being triggered by an initial injury to mesothelial pericardial cells combined with blood in the pericardial space, which leads to an immune complex deposition in the pericardium, pleura, and lungs and an inflammatory response.

Dressler Syndrome: Risk Factors

Dressler's syndrome can affect persons of any age or race, although it seems to affect them most frequently between the ages of 20 and 50. The following are risk factors that increase your risk of developing Dressler's syndrome: chest pain (myocardial infarction). Heart operation.

Dressler Syndrome: Diagnosis

The diagnosis of Dressler syndrome is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes

During a complete physical examination, a medical professional uses a stethoscope to listen to the patient's heart. When the pericardium is inflamed or when the fluid has accumulated around the heart, a noise known as a pericardial rub may be heard.

The following tests can be used to identify Dressler syndrome −

• Thorough blood count. The majority of individuals with Dressler syndrome have elevated white blood cell counts.

• Assess inflammation using blood testing. Increased erythrocyte sedimentation rate (sed rate) and C-reactive protein levels can both point to inflammation associated with Dressler syndrome.

• Electrocardiogram (ECG or EKG). Using wires affixed to the skin, this rapid, painless examination monitors electrical impulses in the heart. Pressure on the heart can be indicated by specific changes in the electrical signals.

• A chest X-ray. Fluid around the heart or lungs can be found with the use of a chest X-ray. Moreover, it might aid in ruling out additional reasons for the fluid, such as pneumonia.

• Echocardiogram. The heart is visualized by sound waves, which can reveal whether fluid is accumulating around it.

• Heart MRI. In this examination, sound waves are used to produce still or moving images of the heart's blood flow. This examination might reveal pericardial thickening

Dressler Syndrome: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Nonsteroidal anti-inflammatory medicines (NSAIDs), including those listed below, are the principal form of therapy for Dressler syndrome −

• Ibuprofen, Aspirin, and Colchicine

• Aspirin is typically favored over other NSAIDs when Dressler syndrome follows a heart attack.

• Indomethacin may also be administered.

Corticosteroids

Corticosteroids may be the next course of action if those drugs are ineffective. These potent immunosuppressants can lessen Dressler syndrome-related inflammation.

Corticosteroids may hinder the recovery of injured cardiac tissue following a heart attack or surgery and can have dangerous adverse effects. Corticosteroids are often only used as a last resort after all other therapeutic options have failed.

Dressler Syndrome: Prevention

Colchicine, an anti-inflammatory drug, may help avoid Dressler syndrome if taken before cardiac surgery, according to certain studies.

Conclusion

All patients who are getting discharged should be informed that they must come back for an evaluation right away if symptoms of Dressler syndrome, such as signs of infection development (such as fevers, altered mentation, increased shortness of breath, and palpitations), progressing effusion, or syncope, appear. The prescribing doctor should set up any cardiology follow-up appointments.

Dressler syndrome is difficult to diagnose and is often misdiagnosed as other heart conditions. As a result, an interprofessional team composed of a cardiac nurse, emergency department doctor, cardiologist, radiologist, and intensivist is the best option for managing it. Unless the patient is hemodynamically unstable, the majority of patients with suspected Dressler syndrome get treatment in an outpatient setting with regular follow-up.

When the accumulated pericardial fluid decreases, the dosage of NSAIDs (such as aspirin, ibuprofen, and naproxen) is routinely decreased throughout 4 to 6 weeks. A 1-week treatment of corticosteroids (such as prednisone) tapered over 4 weeks may be administered to patients who do not respond to NSAID therapy. The cardiac surgeon or cardiologist may recommend pericardial drainage in more severe Dressler syndrome instances.

The majority of people with Dressler syndrome have great prognoses, yet the healing process can take two to four weeks.