CardiologyTier 2Disease (DEADMAN)

Pericardial disease - Dressler syndrome

Description

A delayed, immune-mediated pericarditis occurring weeks-months after myocardial infarction (or cardiac surgery/trauma) - distinct from the early (peri-infarction) pericarditis seen in the first few days post-MI

Epidemiology

Much less common now given early reperfusion therapy limits infarct size; classically 2-10 weeks post-MI

Aetiopathogenesis

Thought to be an autoimmune reaction to exposed myocardial/pericardial neoantigens released by infarcted tissue - analogous mechanistically to post-cardiotomy syndrome after cardiac surgery

Diagnosis

Pleuritic chest pain, fever, pericardial rub, raised inflammatory markers (ESR/CRP), +/- pericardial effusion on echo, in the appropriate time window after MI/cardiac injury
A clinical diagnosis of exclusion once other post-MI complications (recurrent ischaemia, mechanical complication) are excluded

Management

NSAIDs/aspirin first-line (aspirin preferred over other NSAIDs in the early post-MI period given interference with infarct healing/increased rupture risk with other NSAIDs)
Colchicine as an adjunct to reduce recurrence
Corticosteroids reserved for refractory cases (can impair infarct healing, generally avoided if possible)

Associations

Post-MI, post-cardiac surgery (post-pericardiotomy syndrome), pericardial effusion, recurrent pericarditis

Natural history & complications

Usually self-limited with treatment; recurrence can occur (a shared feature with other forms of pericarditis) - tapering anti-inflammatory therapy slowly reduces recurrence risk

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