Dressler’s syndrome

Dressler’s Syndrome, also known as post-myocardial infarction syndrome, is a type of inflammation that occurs in the pericardium (the sac-like membrane surrounding the heart) following a heart injury, particularly a heart attack (myocardial infarction), heart surgery, or trauma. It is believed to result from an autoimmune response triggered by damage to heart tissue.

Causes:

Dressler's syndrome is considered an autoimmune condition, meaning the body's immune system mistakenly attacks its own tissues. After heart injury:

• Damaged heart cells release substances that the immune system identifies as foreign.
• This triggers an inflammatory response in the pericardium.

Symptoms:

Symptoms typically appear weeks to months after the heart injury and include:

1. Chest Pain:
   • Sharp and pleuritic (worsens with deep breathing or lying down).
   • Often improves when sitting up and leaning forward.
2. Fever:
   • Low-grade or moderate fever due to inflammation.
3. Pericardial Effusion:
   • Accumulation of fluid in the pericardial sac, which may cause:
     • Shortness of breath.
     • Palpitations.
4. General Symptoms:
   • Fatigue.
   • Weakness.
   • Muscle aches.

In severe cases, it can lead to cardiac tamponade, a life-threatening condition where excessive fluid buildup compresses the heart, impairing its ability to pump blood effectively.

Risk Factors:

• Recent heart attack (especially large ones).
• Open-heart surgery (e.g., bypass or valve surgery).
• Chest trauma or cardiac procedures.
• Personal or family history of autoimmune diseases.

Diagnosis:

Diagnosis is based on clinical history and tests:

1. Physical Examination:
   • Pericardial friction rub: A scratchy sound heard with a stethoscope, indicating pericardial inflammation.
2. Electrocardiogram (ECG/EKG):
   • May show signs of pericarditis, such as widespread ST elevation or PR depression.
3. Echocardiogram:
   • Detects pericardial effusion or inflammation.
4. Chest X-ray:
   • May show an enlarged cardiac silhouette if significant fluid accumulates.
5. Blood Tests:
   • Elevated inflammatory markers (C-reactive protein or erythrocyte sedimentation rate).

Treatment:

The primary goal is to reduce inflammation and prevent complications:

1. Anti-inflammatory Medications:
   • Aspirin or NSAIDs (e.g., ibuprofen): First-line treatment.
   • Colchicine: Often added to reduce recurrence.
2. Corticosteroids:
   • Used in severe cases or when other medications fail.
   • May increase the risk of recurrence when tapered too quickly.
3. Pericardiocentesis:
   • If fluid buildup is significant or life-threatening, a procedure may be performed to remove excess fluid.
4. Antibiotics:
   • If there is evidence of infection (rare in Dressler's syndrome but important to rule out).

Prognosis:

With appropriate treatment, most people recover fully. However:

• Symptoms can recur, requiring ongoing management.
• Untreated or severe cases can lead to complications like constrictive pericarditis or cardiac tamponade.

Prevention:

There is no guaranteed way to prevent Dressler’s syndrome, but proper management of heart conditions, prompt treatment of heart injuries, and close monitoring after cardiac procedures can reduce the risk.

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