Overview

Dressler syndrome is a type of inflammation of the sac surrounding the heart (pericarditis). Dressler syndrome is believed to be an immune system response after damage to heart tissue or to the sac surrounding the heart (pericardium). Such damage may occur from events such as a heart attack, surgery or traumatic injury. Symptoms include chest pain, which may be similar to chest pain experienced during a heart attack.

Dressler syndrome may also be called post-myocardial infarction syndrome, post-traumatic pericarditis, post-cardiac injury syndrome and post-pericardiotomy syndrome.

Symptoms

Symptoms are likely to appear weeks to months after a heart attack, surgery or injury to the chest. Symptoms might include:

• Chest pain
• Fever

When to see a doctor

Seek emergency care for sudden or persistent chest pain, which may signal a heart attack or other serious disorder.

Causes

Experts think Dressler syndrome is caused by the immune system's response to heart damage. Your body reacts to the injured tissue by sending immune cells and proteins (antibodies) to clean up and repair the affected area. Sometimes this response causes excessive inflammation in the pericardium.

Dressler syndrome may occur after certain heart surgeries or procedures.

Complications

The immune system reaction that causes Dressler syndrome might also lead to fluid buildup in the tissues surrounding your lungs (pleural effusion).

Rarely, Dressler syndrome can cause more-serious complications, including:

• Cardiac tamponade. Inflammation of the pericardium can cause fluids to accumulate in the sac (pericardial effusion). The fluid can put pressure on the heart, forcing it to work harder and reducing its ability to pump blood efficiently.
• Constrictive pericarditis. Recurring or chronic inflammation can cause the pericardium to become thick or scarred. The scarring can reduce the heart's ability to pump blood efficiently.

Prevention

Some preliminary studies suggest that taking the anti-inflammatory medication colchicine before heart surgery might help prevent Dressler syndrome.

Diagnosis

Your doctor will do a thorough physical examination, including listening to your heart with a stethoscope. A specific sound, called a pericardial rub, can occur when your pericardium is inflamed or when fluid has collected around your heart.

Your doctor might then recommend tests, such as:

• Complete blood count. Most people with Dressler syndrome have an increased white blood cell (WBC) count.
• Blood tests to measure inflammation. A higher than normal level of C-reactive protein and an increased erythrocyte sedimentation rate (sed rate) can indicate inflammation that's consistent with Dressler syndrome.
• Electrocardiogram (ECG or EKG). This painless, quick test records electrical signals in your heart through wires attached to your skin. Certain changes in the electrical signals can indicate pressure on your heart. But EKG readings may be abnormal after heart surgery, so your doctor will consider results of additional tests when diagnosing Dressler syndrome.
• Chest X-ray. A chest X-ray can help detect fluid around the heart or lungs. It can also help rule out other causes of your symptoms, such as pneumonia.
• Echocardiogram. Sound waves produce an image of your heart, helping your doctor to see if fluid is collecting around it.
• Cardiac magnetic resonance imaging (MRI). A cardiac MRI uses sound waves to create still or moving pictures of how blood flows through the heart. This test can show thickening of the pericardium.

Treatment

The goals of treatment for Dressler syndrome are to manage pain and reduce inflammation. Treatment may involve medications and, if complications occur, surgery.

Medications

The main treatment for Dressler syndrome is medication to reduce inflammation. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as:

• Aspirin
• Ibuprofen (Advil, Motrin IB, others)
• Colchicine

If Dressler syndrome occurs after a heart attack, usually aspirin is preferred over other NSAIDs.

Indomethacin may also be given.

If those medications don't help, your doctor might prescribe corticosteroids. These powerful immune system suppressants can reduce inflammation related to Dressler syndrome. Corticosteroids can have serious side effects and might interfere with the healing of damaged heart tissue after a heart attack or surgery. For those reasons, corticosteroids are generally used only when other treatments don't work.

Treating complications

Complications of Dressler syndrome can require more-invasive treatments, including:

• Draining excess fluids. If you develop cardiac tamponade, your doctor will likely recommend a procedure (pericardiocentesis) in which a needle or small tube (catheter) is used to remove the excess fluid. The procedure is usually done using a local anesthetic.
• Removing the pericardium. If you develop constrictive pericarditis, you might need surgery to remove the pericardium (pericardiectomy).

Preparing for an appointment

If you're being seen in the emergency room for chest pain, you might be asked:

• When did your symptoms begin?
• Can you rate the severity of your chest pain, such as on a scale of 1 to 10?
• Does anything worsen symptoms? For example, does it hurt more when you inhale deeply?
• Where is the pain located? Does it extend anywhere beyond your chest?
• Have you had a recent event that could cause tissue damage to the heart, such as a heart attack, heart surgery or blunt trauma to your chest?
• Do you have a history of heart disease?
• What prescription or over-the-counter medications are you taking?