Dressler’s Syndrome

Dressler’s syndrome — also called post-myocardial infarction syndrome — is a rare form of pericarditis that can happen after a heart attack. Pericarditis is inflammation of the sac that surrounds your heart (pericardium). 

At first, there’s what experts call a “latent period.” This ranges from several days to weeks. During this time, your immune system reacts to the damage from the heart attack. This immune response leads to pericardial inflammation.

As with other forms of pericarditis, Dressler’s syndrome can cause chest pain. This occurs when your inflamed pericardium rubs against your heart. Excess fluid can also build up between your pericardium’s two layers (pericardial effusion). This puts pressure on your heart. Medicines are usually enough to reduce inflammation and prevent complications.

In the past, Dressler’s syndrome affected 3 to 5 out of every 100 people who had a heart attack. Today, thanks to advances in heart attack treatment, fewer than 1 in 100 people who have a heart attack develop Dressler’s syndrome.

Symptoms of Dressler’s syndrome

Symptoms most often develop two to four weeks after a heart attack. The most common symptom of Dressler’s syndrome is chest pain that’s sharp and stabbing. The pain may get worse when you take deep breaths, swallow, cough or lie down. Sitting up and leaning forward may ease the pain.

Besides chest pain, other possible symptoms include: 

• Trouble breathing, especially when you lean back or lie down
• Low-grade fever
• Fatigue
• A general sense of discomfort or unease (malaise)
• Fast heart rate and low blood pressure, which are signs of cardiac tamponade

Dressler’s syndrome causes

Experts don’t fully understand what causes Dressler’s syndrome. But they believe it’s your immune system’s response to a heart attack. The damage to your heart tissue sets off a chain reaction of immune activity that leads to inflammation of your pericardium.

You might hear your healthcare provider call Dressler’s syndrome a post-cardiac injury syndrome (PCIS). PCIS is an umbrella term for a group of conditions that involve an immune system response to heart damage. Other forms of PCIS happen after heart surgery or a traumatic injury.

Complications of this condition

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 of Dressler’s syndrome may include:

• Cardiac tamponade. There’s so much fluid around your heart that it can’t pump enough blood. This issue can be fatal without treatment.
• Constrictive pericarditis. Your pericardium becomes too thick or stiff. This prevents your heart from beating properly and can lead to serious problems like heart failure.

How doctors diagnose this condition

If your healthcare provider suspects you have Dressler’s syndrome, they’ll do a physical exam and talk to you about your symptoms. Tests you may need include:

1. Blood tests. These check for signs of inflammation in your body, like elevated C-reactive protein.
2. Electrocardiogram (ECG/EKG). An EKG creates a graph of your heart’s electrical activity that can reveal heart inflammation.
3. Chest X-ray. X-rays can detect an increase in heart size, which might mean there’s fluid buildup.
4. Echocardiogram. An echo can show if there’s fluid buildup around your heart. It can also show if this fluid is harming your heart muscle.
5. Cardiac MRI. This imaging test can show your heart in greater detail and identify inflammation. You might need it if other tests don’t provide enough information on your condition.

Signs your provider will look for when reaching a diagnosis include:

• A scratching or creaking sound when they listen to your heart with a stethoscope (pericardial friction rub)
• A rough, grating sound when they listen to your lungs as you breathe in and out (pleural rub)
• Blood test results that suggest inflammation, like elevated C-reactive protein levels or white blood cell levels
• EKG signs that mean your pericardium is inflamed or you have pericardial effusion

Your provider may diagnose you with Dressler’s syndrome if you meet at least two of the following criteria:

• You have a fever without another known cause.
• You’re having chest pain typical of pericarditis.
• Your provider can hear a pericardial rub and/or pleural rub in your chest.
• You have excess fluid in your pericardium (pericardial effusion).
• You have excess fluid around your lungs (pleural effusion) as well as elevated C-reactive protein levels.

How is Dressler’s syndrome treated?

Usually, medicines are enough to reduce inflammation of your pericardium and relieve symptoms of Dressler’s syndrome. You’ll need to take these for weeks (or possibly months) until your symptoms go away. Your provider may prescribe aspirin and colchicine.

If your condition becomes chronic, you’ll need to see an expert in pericardial disease for advanced treatment options.

When should I see my healthcare provider?

Follow the appointment schedule your provider gives you. Follow-ups are important so your provider can see how well treatment is working. You should also call your provider right away if you have new or worsening symptoms.

What can I expect if I have this condition?

The outlook for Dressler’s syndrome is good with prompt treatment. Be sure to keep taking the medicines your healthcare provider prescribes and follow the instructions they give you.

Dressler’s syndrome may come back after treatment. This is why it’s important to see your provider for routine checkups even after you feel better. Your provider will keep a close eye on your heart. They’ll let you know if you need further treatments.