Dressler’s Syndrome

What is Dressler's Syndrome?

Dressler's syndrome, also called postmyocardial infarction syndrome, is a form of pericarditis, inflammation of the sac around the heart, with or without fluid in that sac, that follows injury to the heart or pericardium.^[1] It belongs to a group called post-cardiac injury syndromes, which also includes inflammation after heart surgery.^[2] It needs prompt medical diagnosis and treatment.

Common symptoms

The typical symptom is sharp chest pain that gets worse when lying down and eases when sitting up and leaning forward.^[3] Fever, tiredness and malaise are common, and a build-up of fluid around the heart can cause shortness of breath or palpitations.^{[1, 4]}

• Sharp chest pain, worse with deep breaths or lying flat
• Low-grade fever
• Fatigue, weakness or muscle aches
• Shortness of breath or palpitations if fluid collects

The condition should be considered when malaise or fatigue persist after a heart attack or cardiac surgery, especially more than two weeks after the event.^[1]

Causes and risk factors

Dressler's syndrome follows injury to the heart or pericardium, most often a heart attack or cardiac surgery.^[1] The exact mechanism is described as an inflammatory response to that injury, and procedures on the heart are now a more common setting than heart attack itself.^[2]

How it is diagnosed and treated conventionally

Pericarditis is diagnosed when at least two of these are present: characteristic chest pain, widespread ECG changes, new or larger pericardial fluid on imaging, or a pericardial friction rub heard on exam.^[3]

Treatment is usually high-dose NSAIDs with a gradual taper, plus a 3-month course of colchicine to relieve symptoms and lower the risk of recurrence.^[3] Corticosteroids are used if this does not work, and interleukin-1 blockers may be used in people with multiple recurrences.^[3] Most people have a benign course, but about 15% to 30% have a recurrence, and fluid can rarely compress the heart (tamponade), which is life-threatening.^[3]

Why Dressler's Syndrome calls for a whole-person approach

Dressler's syndrome happens in people who have already had a major cardiac event, so the recovery of the heart, medicines, sleep, stress and energy all matter at once. Treatment has to balance calming inflammation against allowing the heart to heal.^[2]

Supportive care looks at the person around the diagnosis. It does not treat the pericarditis, and it is never a substitute for cardiology care.

Inflammation after cardiac injury

Reviews describe pericarditis as a stereotyped immune and inflammatory response to a variety of triggers, and anti-inflammatory drugs are its mainstay of treatment.^[4] This is a medical problem for your cardiologist.

Recurrence and long recovery

Recurrence affects 15% to 30% of patients with pericarditis, and in some people it continues for years.^[3] A long, uncertain course can disturb sleep and mood.

Medication burden

In a meta-analysis of 10 trials, colchicine was associated with more side effects than comparison treatments, mainly gastrointestinal ones.^[5] People often take several drugs at the same time, which makes careful review of any herb or supplement important.^{[3, 6]}

Sleep and stress

Poor sleep and stress are common after a cardiac event, and are a reasonable focus of supportive care, even though no studies address them specifically in Dressler's syndrome.

Acupuncture as supportive care in Dressler's Syndrome

What the research shows

No clinical trials of acupuncture for Dressler's syndrome or post-pericardiotomy pericarditis were found in PubMed, so we cannot say it helps the condition.

The closest research is in angina. A systematic review of 16 studies found acupuncture alongside conventional drugs eased angina symptoms and improved ECG results more than drugs alone, but the studies had high or moderate risk of bias, and the reviewers concluded acupuncture is not suitable for emergency treatment of heart attack.^[7] That is a different condition from pericarditis.

For sleep, a review of 24 trials in insomnia included a meta-analysis of 15 trials in which acupuncture improved sleep scores compared with medication, with high variability between trials.^[8]

How acupuncture may work

No research explains how acupuncture might affect pericarditis, so we make no claim about mechanism.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at selected points, usually left in for about 20 to 40 minutes. A course is several visits with reassessment along the way.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[9] Needle placement near the heart matters in anyone with pericardial disease: a systematic review of case reports found cardiac tamponade, the most common complication, when needles were placed close to the heart, with high mortality.^[10] For that reason, tell your practitioner about your pericarditis so that needling over the chest can be avoided, and check with your cardiologist first. Tell the practitioner if you take blood thinners or aspirin, have a bleeding disorder or a pacemaker or defibrillator (relevant to electroacupuncture), or are pregnant.

Ayurvedic medicine as supportive care in Dressler's Syndrome

The Ayurvedic view

Ayurveda has no classical name for Dressler's syndrome. Inflammation around the heart may be described in terms of the heart region (hridaya) and an imbalance of Pitta, with ama (undigested residue) in the channels. These are traditional frameworks for choosing care, not biomedical diagnoses. Pericarditis itself is treated with anti-inflammatory drugs under medical supervision.^[4]

Therapies that may be used

Care is individualized and traditionally combines:

• Regular meals, sleep times and gentle daily routine
• Breathing practices and relaxation, within the limits set by your cardiologist
• Light oil massage that avoids strong pressure over the chest
• Herbs prescribed individually, only after your cardiology team has reviewed them

Panchakarma, the traditional cleansing series, is not appropriate during pregnancy, acute illness or frailty, which includes the weeks after a recent heart attack or heart surgery and any time pericarditis is active.

What the research shows

No studies of Ayurvedic treatment for Dressler's syndrome or pericarditis were found. Research on ashwagandha (Withania somnifera) is for symptoms in other groups: meta-analyses of placebo-controlled trials found it reduced stress and anxiety scores and gave a small improvement in sleep, with low-certainty evidence for stress and anxiety and limited long-term safety data.^{[11, 12]} This does not show benefit in cardiac patients, and any herb, including ashwagandha, should be cleared with your cardiology team first.

Herbal medicine as supportive care in Dressler's Syndrome

Herbs and formulas that have been studied

No herbs or formulas have been studied in Dressler's syndrome. Chinese patent medicines have been studied for the heart attack itself. One is Tongxinluo, which was tested in a large trial in people with STEMI.^[13]

What the research shows

In the Tongxinluo trial, 3,777 patients with STEMI in China received it or placebo for a year on top of standard treatment. Major cardiac and cerebrovascular events were lower with Tongxinluo, with more digestive side effects.^[13] A later network meta-analysis of 160 trials of blood-activating Chinese patent medicines around stenting found no significant effect on major cardiovascular events. It found possible improvements in blood flow after stenting and in angina.^[14] These studies concern heart attack and not Dressler's syndrome, so they cannot show that herbs help pericarditis.

Safety and herb-drug interactions

Herbs can interact with the drugs commonly used here. Reviews report enhanced bleeding when warfarin was taken with danshen, garlic or ginkgo, bleeding when ginkgo was combined with aspirin, and altered drug levels with St. John's wort.^[6] A systematic review of 149 articles on warfarin found 78 herbs, foods or supplements reported to interact with it.^[15] Some herbs also affect heart rhythm and blood pressure and increase bleeding risk around surgery.^[16]

Because NSAIDs, aspirin, colchicine, steroids and blood thinners may all be in use, every herb should be reviewed by your cardiologist or pharmacist first. About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[17] Tell us if you are pregnant or breastfeeding or have liver or kidney disease.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine may describe pain and tightness in the chest in terms of qi and blood stasis, and Ayurveda in terms of Pitta and ama in the heart region. Researchers describe pericarditis as an inflammatory response to cardiac injury.^[4]

Studies of blood-activating Chinese medicines in heart attack look at reperfusion, angina and cardiac events, which loosely parallel the idea of moving blood stasis.^[14] No study has shown that these traditional concepts correspond to the inflammation seen in Dressler's syndrome.

How this care fits with your medical care

Supportive care is complementary. Keep your cardiologist and primary physician, and do not stop or change prescribed medicines without your prescriber, especially colchicine, NSAIDs, aspirin, steroids and blood thinners. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

We do not diagnose or manage Dressler's syndrome. Please bring your diagnosis, discharge or surgical summaries, recent ECG and echocardiogram results, and a complete list of medicines and supplements.

When to seek urgent medical care

Chest pain after a heart attack or heart surgery always needs to be assessed by a physician, because it can be a sign of pericarditis, another heart problem or a new heart attack.^[3]

• New or worsening chest pain, or chest pain with sweating, nausea or pain spreading to the arm or jaw
• Shortness of breath, or being unable to lie flat
• Fainting, severe dizziness, a racing heartbeat or very low blood pressure
• Swelling of the neck veins, legs or abdomen
• Fever with chest pain
• Chest pain that returns after you have stopped treatment

If you have any of these, call 911 or go to the nearest emergency department.