Dressler’s syndrome or post-myocardial infarction pericarditis . It is a swelling and inflammation of the covering of the heart ( pericardium ) and it is a condition that can appear in the days or weeks after a heart attack.
Summary
[ hide ]
- 1 Causes
- 2 Risk factors
- 3 types
- 4 Symptoms
- 5 Signs and tests
- 6 Treatment
- 7 Forecast
- 8 Complications
- 9 Sources
Causes
Its cause is unknown, since its initial description is attributed to an autoimmune origin in relation to the appearance in the blood of antibodies directed against certain myocardial or pericardial antigens exposed to the immune system at the time of the infarction, although it has also been related to the existence of a latent viral infection or with the entry of blood into the pericardial sac during previous acute myocardial infarction (AMI) and treatment by oral anticoagulation (justifying the lower incidence of Dressler in recent years due to the non-use of these drugs in the current treatment of AMI).
Risk factor’s
- Similar initial insult in both affections of the pericardial endothelial cells and entry of blood into the pericardial sac.
- Similar delayed response in both conditions with fever and inflammation of the pericardial surface.
- Antimyocardial Antibody Development
- Generally positive response to anti-inflammatory drugs
- Similar trend to recurrence of the picture
Types
Two types can occur after a heart attack. The first type occurs more frequently within 2 to 5 days after a heart attack . When the body tries to cleanse the diseased heart tissue, swelling and inflammation occur . The second type is also called Dressler’s syndrome (or postcardiac injury syndrome or pericarditis.postcardiotomy) and occurs several weeks or months after a heart attack, heart surgery, or other trauma to the heart. Dressler’s syndrome is believed to be caused by the immune system attacking the area. Pain occurs when the pericardium becomes inflamed (swollen) and brushes the heart. You are at increased risk for pericarditis if you have had a previous heart attack, open heart surgery, or chest trauma, or if the heart attack affected the thickness of the myocardium.
Symptoms
- Anxiety
- Chest pain:
- It can come and go (reappear)
- It can be sharp and stabbing (pleuritic) or tight and oppressive (ischemic)
- May worsen with breathing and may disappear when standing or sitting
- Radiates to the neck , shoulder , back, or abdomen
- Difficulty breathing
- Dry cough
- Rapid heart rate ( tachycardia )
- Fatigue
- Fever (more common with the second type of pericarditis)
- Malaise (general indisposition)
- Holding your ribs (bending or holding your chest) with deep breathing
Signs and tests
The doctor will use a stethoscope to listen to the heart and lungs. A friction sound may occur (called pericardial rubbing, not to be confused with a murmur). Heart sounds in general can be faint or sound distant. A build-up of fluid in the covering of the heart or the space around the lungs (pericardial effusion) is not common after a heart attack, but it often does occur in some patients with Dressler’s syndrome. The exams can be, among others:
- Cardiac injury markers (CK-MB and troponin can help differentiate pericarditis from a heart attack)
- CT scan of the chest
- Magnetic resonance imaging of the chest
- Chest x-ray
- Complete blood count
- ECG ( electrocardiogram )
- Echocardiography
- ESR (erythrocytic sedimentation rate) or C-reactive protein (measures of inflammation)
Treatment
The goal of treatment is to make the heart work better, as well as reduce pain and other symptoms.
Acetylsalicylic acid ( aspirin ) or nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to treat inflammation of the pericardium. Acetylsalicylic acid, even in high doses, is usually preferred in early post-myocardial infarction pericarditis. In extreme cases, when other medications don’t work, steroids or colchicine can be used.
In some cases, it may be necessary to remove excess fluid around the heart (pericardial effusion), which is done with a procedure called pericardiocentesis. In the event of complications, removal of part of the pericardium may be required with surgery (pericardiectomy).
Forecast
The condition may come back, even in people receiving treatment. In some cases, untreated post-infarct pericarditis is life-threatening.
Complications
The possible complications that it brings with it are:
- Cardiac tamponade
- Congestive heart failure
- Constrictive pericarditis
