Dressler's syndrome
Background
- Also known as late post-MI pericarditis
- Pericarditis that occurs one week to several months after a myocardial infarction
- Thought to be immunologic and is less commonly seen after PE, pericardial trauma, or pericardiectomy.[1]
Clinical Features
Signs and Symptoms
- Pleuritic chest pain
- Fever
- Malaise
- Pericardial friction rub
Findings
- EKG findings characteristic of pericarditis
- Pericardial effusion
- Pleural effusion
- Leukocytosis, elevated ESR or CRP[2]
Differential Diagnosis
ST Elevation
- Cardiac
- ST-segment elevation myocardial infarction (STEMI)
- Post-MI (ventricular aneurysm pattern)
- Previous MI with recurrent ischemia in same area
- Wellens' syndrome
- Coronary artery vasospasm (eg, Prinzmetal's angina)
- Coronary artery dissection
- Pericarditis
- Myocarditis
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Myocardial tumor
- Myocardial trauma
- RV pacing (appears as Left bundle branch block)
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
- Other thoracic
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Medications
Evaluation
- EKG
- Labs
- CBC
- CRP/ESR
- Troponin: to rule out concurrent myocarditis
- Imaging
Diagnosis
- Need 2 of the following diagnostic criteria for acute pericarditis[3]
- Chest pain (typically sharp and pleuritic, improved by sitting up and leaning forward)
- Pericardial friction rub
- New or worsening pericardial effusion
- Suggestive ECG changes
AND
- Appropriate time-frame: 1 week to approximately 3 months after cardiac injury
Management
- NSAIDs: There is no evidence that a specific NSAID has increased efficacy, so NSAID choice is typically based on whether there are other indications for an NSAID or likelihood of side effects.
- Colchicine: may be used in conjunction with NSAIDs[5]
- Glucocorticoids: can be used for refractory Dressler's syndrome
Disposition
- Admission not typically necessary, but should be considered in patients with:
- Myopericarditis
- Cardiac tamponade
- Hemodynamic instability
- Patients should follow up as an outpatient for repeat inflammatory markers in approximately one month.[6]
See Also
External Links
References
- ↑ Jouriles N. Pericardial and Myocardial Disease. In: Rosen's Emergency Medicine: Concepts and Clinical Practice: Volume 1. Philadelphia: Mosby/Elsevier; 2010.
- ↑ Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol. 2013;168(2):648–652. doi:10.1016/j.ijcard.2012.09.052
- ↑ Imazio M, Gaita F, LeWinter M. Evaluation and Treatment of Pericarditis: A Systematic Review. JAMA 2015;314(14):1498–506.
- ↑ Imazio M, Spodick DH, Brucato A, Trinchero R, Adler Y. Controversial issues in the management of pericardial diseases. Circulation. 2010;121(7):916–928. doi:10.1161/CIRCULATIONAHA.108.844753
- ↑ Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36(42):2921–2964. doi:10.1093/eurheartj/ehv318
- ↑ Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol. 2013;168(2):648–652. doi:10.1016/j.ijcard.2012.09.052