About Dressler’s syndrome

Dressler’s syndrome is a complication that can occur following a heart attack or heart surgery. It occurs when the sac that surrounds your heart (pericardium) becomes inflamed. An immune system reaction is thought to be responsible for Dressler’s syndrome, which usually develops several weeks or months after heart tissue injury.

Dressler’s syndrome causes fever and chest pain, which can feel like another heart attack. Also referred to as post-pericardiotomy and post-myocardial infarction syndrome, Dressler’s syndrome is treated with medications that reduce inflammation.

With recent improvements in the medical treatment of heart attack, Dressler’s syndrome is far less common than it used to be. However, once you’ve had the condition, it may recur, so it’s important to be on the lookout for any symptoms of Dressler’s syndrome if you’ve had a heart attack, heart surgery or other heart injury.

Symptoms

Dressler’s syndrome causes the following signs and symptoms after heart surgery, a heart attack or an injury to your heart:

  • Chest pain
  • Shortness of breath or pain when breathing (pleurisy)
  • Fever
  • Left shoulder pain

Causes

Dressler’s syndrome is thought to develop from an overactive immune system response to heart tissue damage, such as from a heart attack or heart surgery. Your body reacts to the injured tissue as it would to any injury, by sending immune cells and proteins called antibodies to clean up and repair the affected area. But this response appears to cause excessive inflammation in the sac enveloping the heart (pericardium), and the symptoms of Dressler’s syndrome develop.

Some older studies estimated that Dressler’s syndrome developed in about 3 percent to 4 percent of people who’d had a heart attack. But because of improvements in the treatment of heart attack — which reduce the amount of damage done to heart tissue — the occurrence of Dressler’s syndrome today is less common.

Diagnosis

Your doctor may diagnose Dressler’s syndrome based on your medical history and signs and symptoms, by listening to your heart, and sometimes by using blood tests. Other diagnostic tests may include:

  • Echocardiogram. An echocardiogram uses sound waves to produce an image of your heart. This test allows your doctor to see if fluid is collecting around your heart.
  • Electrocardiogram. An electrocardiogram records the electrical impulses in your heart through wires attached to the skin. Certain changes in the electrical impulses may mean there’s pressure on your heart.
  • Chest X-ray. This X-ray can help detect fluid building up around the heart or lungs and can help exclude other causes of your symptoms, such as pneumonia.

Complications

Two rare but serious complications of Dressler’s syndrome are:

  • Cardiac tamponade. This condition occurs when fluid builds up around the heart and presses on it, reducing its ability to pump well. Treatment requires a procedure called pericardiocentesis, in which fluid is removed with a fine needle.
  • Constrictive pericarditis. This condition develops from repeated inflammation of the sac around the heart (pericardium). The inflammation causes the pericardium to become thick and scarred. Treatment requires surgery to remove the pericardium (pericardiectomy).

Other complications include:

  • Pleurisy. This is inflammation of the membranes around your lungs.
  • Pleural effusion. This is a buildup of fluid around your lungs.

Treatment

Mild cases of Dressler’s syndrome may improve without treatment. Your doctor may recommend decreasing your activity until you’re feeling better.

More-severe cases require medications to reduce the inflammation around your heart. Sometimes hospitalization is necessary.

Medications to treat Dressler’s syndrome include:

  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs work by inhibiting an enzyme called cyclooxygenase (COX). This enzyme is responsible for your body’s production of prostaglandins, hormone-like substances involved in inflammation and pain. NSAIDs are the most common treatment for Dressler’s syndrome.
  • Other pain medications. If your pain is severe, you might need stronger pain medications, such as a narcotic, for a short time.
  • Corticosteroids. These drugs, which include prednisone, mimic the effects of certain hormones in your body, such as cortisone, which are produced by your adrenal glands. When an inflammatory illness strikes, additional cortisone in the form of corticosteroids helps suppress inflammation, which reduces the symptoms of Dressler’s syndrome. However, corticosteroids have potential side effects, and there’s a risk of rebound inflammation after you stop taking corticosteroids. Your doctor may recommend corticosteroids if NSAIDs aren’t working for you.
  • Colchicine. For resistant cases of Dressler’s syndrome or for people who have repeated episodes of pericarditis, colchicine is another type of anti-inflammatory medication that has been effective in some cases. It’s often used to treat gout.

Hospitalization sometimes necessary
If a complication develops, such as cardiac tamponade, you’ll likely need hospitalization. When cardiac tamponade occurs, you may undergo a technique called pericardiocentesis. In this procedure, a doctor uses a sterile needle or a small tube (catheter) to remove and drain the excess fluid from the pericardial cavity. You’ll receive a local anesthetic before undergoing pericardiocentesis, which is often done with echocardiogram and ultrasound guidance. This drainage may continue for several days during the course of your hospitalization.

Repeated episodes of Dressler’s syndrome can lead to a condition called constrictive pericarditis. If you develop this complication, you may need to undergo a surgical procedure (pericardiectomy) to remove the entire pericardium that has become rigid.