Dressler’s Syndrome

What is Dressler’s syndrome?

Dressler’s syndrome is a form of pericarditis, or inflammation of the pericardium, a tough elastic sac that surrounds your heart. This may happen when your immune system reacts after some type of damage to your heart.

When your pericardium becomes inflamed, it can rub against your heart and cause chest pain. Excess fluid can also build up between your pericardium’s two layers. This puts pressure on your heart.

Dressler’s syndrome can happen after:

• A heart attack (myocardial infarction).
• Heart surgery.
• A heart procedure.
• Chest trauma from an accident or injury.

Dressler’s syndrome usually occurs within one to six weeks after heart surgery or a heart attack, but it can take up to several months for symptoms to develop.

Other names for Dressler’s syndrome include:

• Post-myocardial infarction syndrome.
• Post-cardiac injury syndrome.
• Post-pericardiotomy syndrome.

Who does Dressler’s syndrome affect?

Dressler’s syndrome can happen in people of any age or race, but it appears to be more common in people who are 20 to 50 years old.

Risk factors that make you more likely to get Dressler’s syndrome include:

• Heart attack (myocardial infarction).
• Heart surgery.
• Heart procedure.
• Chest trauma as the result of an accident or injury.
• Previous use of prednisone (Rayos® or Sterapred®).
• Viral infection.
• Previous case of pericarditis.

How common is Dressler’s syndrome?

Dressler’s syndrome is rare, possibly because of medical advances in treating heart attacks. Only 0.1% of people who have a heart attack get Dressler’s syndrome.

What are the symptoms of Dressler’s syndrome?

Symptoms of Dressler’s syndrome may include:

• Fatigue.
• Weakness.
• Fever.
• Chest pain that’s worse with breathing or lying down, can be felt in your chest, upper back or left shoulder and can get worse with activity.
• Difficult or labored breathing (dyspnea). It may be more difficult to breathe when you recline or lie down.
• Rapid heartbeat (tachycardia) or heart palpitations.
• Pericardial effusion (fluid buildup between your pericardium and your heart).
• Painful joints.
• Less of a desire to eat.

Is Dressler’s syndrome fatal?

Rarely, Dressler’s syndrome symptoms can be life-threatening. It’s important to seek medical treatment if you experience chest pain and have trouble breathing, especially if you’ve recently been in the hospital for heart issues.

What causes Dressler’s syndrome?

Healthcare experts don’t know the exact cause of Dressler’s syndrome. They believe it’s the result of an immune system response following injury or damage to the cells of your heart or pericardium.

Possible Dressler’s syndrome causes include:

• Heart attack (myocardial infarction).
• Heart surgery.
• Invasive procedures, such as cardiac ablation or implantation of a pacemaker.
• Chest injury or trauma.

How is Dressler’s syndrome diagnosed?

Your healthcare provider will perform a physical exam and ask about your medical history, including any type of heart condition you may have. You should tell your provider if you’ve had any:

• Heart attacks.
• Heart surgeries.
• Heart procedures.
• Injuries to your chest area.

Your healthcare provider may order tests to rule out other conditions that have similar symptoms. They’ll make a diagnosis of Dressler’s syndrome based on the combination of:

• Your symptoms.
• The presence of a pericardial friction rub (a scratchy sound they hear with a stethoscope when your inflamed pericardial layers rub together).
• Test results.

What tests will be done to diagnose Dressler’s syndrome?

If your provider thinks you may have Dressler’s syndrome, you’ll need to have further testing. These tests may include:

• Blood tests. A complete blood count (CBC) and blood cultures can rule out an infection. Other blood tests look for elevated C-reactive protein levels or elevated erythrocyte sedimentation rate — both of which would mean that you have inflammation.
• Electrocardiogram (ECG or EKG). This test looks for abnormal electrical activity in your heart that suggests the presence of pericarditis.
• Chest X-rays. X-rays can detect an increase in heart size (due to fluid buildup in your heart).
• Echocardiogram. This test can detect the presence or absence of fluid around your heart (in your pericardium, the lining around your heart muscle), how much fluid, if any, and any potential adverse impact this fluid may be having on your heart muscle.
• Cardiac magnetic resonance imaging (MRI) and CT scan. These imaging tests may be more useful in follow-up to check for thickening or excess fluid in your pericardium or compression of your heart from your thickened pericardium.

Your provider also may want to send a sample of your pericardial fluid to the lab.

How is Dressler’s syndrome treated?

Your healthcare provider can treat Dressler’s syndrome with medications.

Anti-inflammatory drugs can reduce your pain and inflammation. The main treatment is usually either aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. It’s common for your provider to choose one of these dosing schedules:

• High-dose aspirin (750 to 1,000 milligrams every six to eight hours).
• Ibuprofen (600 to 800 milligrams every six to eight hours).

You’ll take less medicine every week as your pericarditis symptoms get better. You’ll take medication for four to six weeks.

If you can’t take aspirin or NSAIDs or they aren’t working, your provider may prescribe:

• Colchicine (Gloperba® or Colcrys®).
• Steroids (prednisone).

You may need surgery if:

• Medicines don’t help.
• Complications develop.

What treatments are used?

If you have a bad case of Dressler’s syndrome, your healthcare provider may do a surgical procedure called a pericardiocentesis. They’ll use a needle to drain fluid from your pericardium. You’ll have a catheter that drains fluid for a day or two, and you'll keep taking medicine, too.

Complications/side effects of the treatment

The risk of pericardiocentesis complications ranges from 4% to 20%, with major complications happening 1% to 2% of the time.

Complications of a pericardiocentesis may include:

• Damage to your heart or a nearby organ.
• Collapsed lung.
• Abnormal heart rhythm.
• Cardiac arrest.
• Bleeding.

How long does Dressler’s syndrome last?

Total treatment time is typically four to six weeks. Usually, you don’t need an overnight stay when you get Dressler’s syndrome treatment.

What are some complications associated with Dressler’s syndrome?

Rarely, complications associated with Dressler’s syndrome can be life-threatening. That’s why it’s important to seek prompt diagnosis and treatment.

Rare complications may include:

• Cardiac tamponade. Excess fluid builds up in your pericardium, which then puts extra pressure on your heart. Severe compression of your heart interferes with its ability to function. Blood pressure drops when blood can’t fill your heart. This issue can be fatal without treatment.
• Constrictive pericarditis. Hardening and/or thickening of your pericardium causes impaired heart function. Your heart may become compressed, which can cause blood to back up into your lungs.

What can I expect if I have Dressler’s syndrome?

It may take two to four weeks to recover, but you’ll need to take medicine for four to six weeks.

Is Dressler’s syndrome curable?

With early diagnosis and treatment, your prognosis is good. However, for 10% to 15% of people, Dressler’s syndrome will come back. After treatment, you should follow up with your healthcare provider and have periodic tests and exams.

How do I take care of myself?

Continue taking the recommended doses of the medicines your healthcare provider prescribed for you. You should also have a follow-up appointment with a cardiologist.

When should I see my healthcare provider?

Contact your provider right away if you have:

• Pain that gets worse.
• Shortness of breath that gets worse.
• Fainting.
• Dizziness.
• Fever.
• Palpitations.

What questions should I ask my doctor?

• How long should I keep taking the medicines you prescribed for me?
• If I need another cardiac procedure, do you think I should take colchicine beforehand?