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'''Dressler syndrome''' is a secondary form of [[pericarditis]] that occurs in the setting of injury to the [[heart]] or the [[pericardium]] (the outer lining of the heart). It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion.
Dressler syndrome is also known as '''postmyocardial infarction syndrome'''<ref name="pmid5039567">{{cite journal |last1=Hutchcroft |first1=B J |title=Dressler's syndrome |journal=BMJ |date=1 July 1972 |volume=3 |issue=5817 |pages=49–9 |pmid=5039567 |pmc=1788531 |doi=10.1136/bmj.3.5817.49-a }}</ref> and the term is sometimes used to refer to '''post-pericardiotomy pericarditis'''.
It was first characterized by [[William Dressler (cardiologist)|William Dressler]] at [[Maimonides Medical Center]] in 1956.<ref name="pmid15539743">{{cite journal |vauthors=Bendjelid K, Pugin J |title=Is Dressler syndrome dead? |journal=Chest |volume=126 |issue=5 |pages=1680–2 |date=November 2004 |pmid=15539743 |doi=10.1378/chest.126.5.1680 }}</ref><ref name="pmid6728756">{{cite journal |vauthors=Streifler J, Pitlik S, Dux S |title=Dressler's syndrome after right ventricular infarction |journal=Postgrad Med J |volume=60 |issue=702 |pages=298–300 |date=April 1984 |pmid=6728756 |pmc=2417818 |doi= 10.1136/pgmj.60.702.298|url=|display-authors=etal}}</ref><ref name="pmid13605300">{{cite journal |author=Dressler W |title=The post-myocardial-infarction syndrome: a report on forty-four cases |journal=Arch Intern Med |volume=103 |issue=1 |pages=28–42 |date=January 1959 |pmid=13605300 |doi=10.1001/archinte.1959.00270010034006 }}</ref>
It should not be confused with the Dressler's syndrome of [[haemoglobinuria]] named for [[Lucas Dressler]], who characterized it in 1854.<ref>{{WhoNamedIt|synd|3982}}</ref><ref>{{cite journal |first1=L. A. |last1=Dressler |title=Ein Fall von intermittierender Albuminurie und Chromaturie |trans-title=A case of intermittent albuminuria and chromaturia |language=Germande |journal=Archiv für pathologischePathologische Anatomie und Physiologie und für klinischeKlinische MedizinMedicin |year=1854 |volume=6 |pages=264-6264–6 |urlhdl=https://hdl.handle.net/2027/hvd.32044093329910?urlappend=%3Bseq=276 }}</ref>
==Presentation==
Dressler syndrome was, historically, a phenomenon complicating about 7% of myocardial infarctions;,<ref>{{cite journal | doi = 10.1056/NEJM198411083111903 |vauthors=Krainin F, Flessas A, Spodick D | title = Infarction-associated pericarditis. Rarity of diagnostic electrocardiogram | journal = N Engl J Med | volume = 311 | issue = 19 | pages = 1211–4 | year = 1984 | pmid = 6493274}}</ref> however,but in the era of [[percutaneous coronary intervention]], it is very uncommon. The disease consists of a persistent low-grade [[fever]], [[chest pain]] (usually [[pleuritic]] in nature), pericarditis (usually evidenced by a [[pericardial friction rub]], chest pain worsening when recumbent, and diffuse ST elevation with PR segment depression), and/or a [[pericardial effusion]]. The symptoms tend to occur 2–3 weeks after myocardial infarction, but can also be delayed for a few months. It tends to subside in a few days, and very rarely leads to [[Cardiac tamponade|pericardial tamponade]].<ref>{{cite journal|last=Hertzeanu|first=H|author2=Almog, C |author3=Algom, M |title=Cardiac tamponade in Dressler's syndrome. Case report.|journal=Cardiology|date=1983|volume=70|issue=1|pages=31–6|pmid=6850684|doi=10.1159/000173566}}<!--|accessdateaccess-date=6 February 2014--></ref> An elevatedElevated [[Erythrocyte sedimentation rate|ESR]] is an objective, yetbut nonspecific, laboratory finding.
==Causes==
It is believed to result from an [[autoimmune]] inflammatory reaction to myocardial neo-[[antigen]]s formed as a result of the [[Myocardial infarction|MI]]. A similarSimilar pericarditis can be associated with any pericardiotomy or trauma to the pericardium or [[cardiac surgery|heart surgery]] which is called a [[postcardiotomy syndrome]].{{factcitation needed|date=March 2019}}
==Diagnosis==
===Differential diagnosis===
Dressler syndrome needs to be differentiated from pulmonary embolism, another identifiable cause of pleuritic (and non-pleuritic) chest pain in people who have been hospitalized and/or undergone surgical procedures within the preceding weeks.{{factcitation needed|date=March 2019}} ischaemic heart disease.
==Treatment==
Dressler syndrome is best treated with high -dose aspirin. In some resistant cases, [[corticosteroids]] can be used but are not preferred (avoided) in the first month due to the high frequency of impaired ventricular healing leading to an increased rate of ventricular rupture. Other [[Non-steroidal anti-inflammatory drug|NSAIDs]], though once used to treat Dressler syndrome, are less advocated and should be avoided in patients with ischemic heart disease. One NSAID in particular, indomethacin, can inhibit new collagen deposition, thus impairing the healing process for the infarcted region. Other NSAIDS should only be used only in cases refractory to aspirin. Heparin in Dressler syndrome should be avoided because it can lead to hemorrhage into the pericardial sac, leading to tamponade. The only time heparin could be used with pericarditis is with coexisting acute MI, in order to prevent further thrombus formation.<ref>{{cite book |last1=Jaffe |first1=AS |last2=Boyle |first2=AJ |chapter=Acute Myocardial Infarction |pages=51–72 |chapterurlchapter-url={{Google books|1X5LCtP2_rwC|page=51|plainurl=yes}} |editor1-first=Michael H. |editor1-last=Crawford |title=CURRENT Diagnosis & Treatment: Cardiology |edition=3rd |location=New York |publisher=McGraw-Hill |year=2009 |isbn=978-0-07-170199-0 }}</ref>
==References==
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