Dressler syndrome is a type of pericarditis, which is the inflammation of the sac around the heart (pericardium). It’s also called post-pericardiotomy syndrome, post-myocardial infarction syndrome, or post-cardiac injury syndrome. This is because the condition typically occurs after a heart surgery, myocardial infarction (heart attack), or injury. Dressler syndrome is thought to occur when the immune system responds excessively following one of these events.
If left untreated, inflammation of the pericardium can lead to scarring, thickening, and muscle tightening of the heart, which can be life-threatening. Treatment for Dressler syndrome includes taking high doses of aspirin or other anti-inflammatory medications. Fortunately, the condition is now considered very rare due to the development of modern treatments for heart attacks.
The exact cause of Dressler syndrome isn’t clear. It’s believed to occur when a heart surgery or heart attack triggers an immune response in the pericardium. In response to an injury, the body typically sends immune cells and antibodies to help repair the area. However, an immune response can sometimes cause an excessive amount of inflammation.
Some of the events that have been known to trigger Dressler syndrome include:
- heart surgery, such as open-heart surgery or coronary artery bypass surgery
- percutaneous coronary intervention, also known as coronary angioplasty and stent placement
- implantation of a pacemaker
- cardiac ablation
- pulmonary vein isolation
- penetrating trauma to the chest
Symptoms can occur two to five weeks after the initial event. In some people, symptoms may not develop for as long as three months.
- chest pain that’s worse when lying down
- chest pain that worsens with deep breathing or coughing (pleuritic pain)
- difficult or labored breathing
- decreased appetite
Dressler syndrome is difficult to diagnose because its symptoms are similar to those of many other conditions. These include pneumonia, pulmonary embolism, angina, congestive heart failure (CHF), and heart attack.
A doctor may suspect you have Dressler syndrome if you start feeling ill a few weeks after a heart surgery or heart attack. They’ll want to conduct tests that help rule out other conditions and confirm a diagnosis.
Your doctor will first take a thorough medical history and perform a physical examination. They’ll listen to your heart with a stethoscope for sounds that might indicate the presence of inflammation or fluid near your heart.
Other tests may include:
- complete blood count (CBC)
- blood cultures to rule out infections
- echocardiogram to look for the presence of fluid near the heart or thickening in the pericardium
- electrocardiogram (ECG or EKG) to look for irregularities in your heart’s electrical impulses
- chest X-ray to see if there’s any inflammation in the lungs
- heart MRI scan, which produces detailed images of the heart and the pericardium
If not treated, inflammation of the pericardium can lead to serious complications. The immune response that causes Dressler syndrome may also cause a condition known as pleural effusion. This is when fluid accumulates in the membranes around your lungs.
In rare cases, the chronic inflammation in the heart can lead to very serious complications, including:
- Cardiac tamponade. This is when fluids build up in the sac around the heart. The fluid puts pressure on the heart and prevents it from pumping enough blood to the rest of the body. This can lead to organ failure, shock, and even death.
- Constrictive pericarditis. This is when the pericardium becomes thick or scarred due to long-term inflammation.
Treatment is aimed at reducing inflammation. Your doctor might suggest taking over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve), or large doses of aspirin. You may have to take them for four to six weeks.
If the OTC anti-inflammatory drugs don’t improve your symptoms, your doctor might prescribe:
- colchicine (Colcrys), an anti-inflammatory medication
- corticosteroids, which suppress the immune system and reduce inflammation
Because of their side effects, corticosteroids are usually a last resort.
If you develop any complications of Dressler syndrome, more aggressive treatments may be needed:
- Pleural effusion is treated by draining the fluid from the lungs with a needle. The procedure is called a thoracentesis.
- Cardiac tamponade is treated with a procedure called pericardiocentesis. During this procedure, a needle or catheter is used to remove excess fluid.
- Constrictive pericarditis may be treated with surgery to remove the pericardium (pericardiectomy).
The outlook for Dressler syndrome is generally favorable. But it does depend on how quickly the condition is diagnosed and treated. Though rare, long-term follow-up is recommended because of the risk of complications, like cardiac tamponade, which can be fatal. A person that has had an episode of Dressler syndrome is at a higher risk of having another episode.
Fortunately, the condition is less common now due to advancements in treatments for heart attacks.