Dressler’s syndrome is a type of pericarditis, wherein the sac surrounding the heart, i.e. the pericardium gets inflamed. The pericardium is a tough elastic sac that surrounds the heart. It consists of two layers, separated by the pericardial fluid. Both the sac and the fluid safeguard the heart against shocks and damages.
Also referred to as post-myocardial infarction syndrome, post-pericardiotomy syndrome, or post-cardiac injury syndrome since it happens as a sort of excessive immune response by the body after damage to the heart tissue or to the pericardium, from events such as a heart attack (myocardial infarction), heart surgery, heart procedure, or chest trauma due to an accident or injury.
Although the exact cause of Dressler syndrome isn't clear, this painful inflamed condition of the heart chiefly occurs as a major immune response to heal the wound and help repair the affected area. But sometimes this response can lead to excessive inflammation in the pericardium. When the pericardium becomes inflamed due to the immune response, it can rub against the heart and cause chest pain. It can also lead to an excess pericardial fluid build-up in between the layers of the pericardium, putting more pressure on the heart.
Some events that can trigger an immune response and cause Dressler’s syndrome includes:
- Heart surgery, including both open-heart surgery and coronary artery bypass surgery
- Implantation of a pacemaker
- Percutaneous coronary intervention, i.e. coronary angioplasty or stent placement
- Pulmonary vein isolation
- Cardiac ablation
- A trauma in the chest
Although it can happen to anyone at any age, it is most commonly witnessed in people of the age 20 to 40 years. Also, those who underwent a recent heart surgery, heart procedure, heart attack (myocardial infarction), or chest trauma are more at risk of getting Dressler’s syndrome.
Dressler’s syndrome normally occurs within two to six weeks after a heart surgery or a heart attack, but it can sometimes take up to several months for symptoms to develop. The common signs and symptoms include:
- Chest pain (that worsens when lying down, while coughing or breathing)
- Pericardial effusion
- Rapid heartbeat or palpitations
- Difficult or labored breathing (dyspnea)
- General debility
- Loss of appetite
If the condition is left untreated for a long time, it can get complicated and cause the following health anomalies:
- Pleural effusion (accumulation of fluid in the membranes around your lungs)
- Cardiac Tamponade (inflammation of pericardium due to accumulation of pericardial fluid)
- Constrictive Pericarditis (Thickening and scarring of the pericardium)
Diagnosis And Treatment
Dressler’s syndrome is quite arduous to understand since the symptoms are similar to other conditions like pulmonary embolism, angina, congestive heart failure (CHF), heart attack or pneumonia. But in case you clearly feel any of the above-mentioned signs or symptoms, after a heart attack or a heart procedure do consult a doctor right away to help rule out other conditions and start the treatment at the earliest. The doctor usually does a thorough physical examination, including listening to the heart beat with a stethoscope. The doctor might also recommend some diagnostics including:
- Blood tests such as a complete blood count (CBC) and blood cultures to rule out infections
- Echocardiogram to check the presence of fluid near the heart or thickening in the pericardium layer
- Electrocardiogram (i.e. ECG or EKG) to analyze any irregularities in the electrical impulses of the heart
- Imaging techniques like X-ray, MRI-scan or CT-scan to get a detailed image of the heart and pericardium
Treatment options usually include anti-inflammatory medications and immuno-suppressants to manage pain and reduce inflammation.
In case of complicated conditions, invasive procedures are conducted. These include:
- Thoracentesis: Draining the fluid from the lungs with a needle in case of pleural effusion
- Pericardiocentesis: Fluid drainage in the case of pericardial effusion or cardiac tamponade
- Pericardiectomy: In case of constrictive pericarditis, a surgical procedure to remove the pericardium