Dressler syndrome
Formal Definition
Dressler syndrome (also called post-myocardial infarction syndrome or post-pericarditis syndrome) — a delayed, immune-mediated pericarditis occurring weeks to months after an initial myocardial injury (acute MI, cardiac surgery, or chest trauma), characterized by pleuritic chest pain, low-grade fever, pericardial friction rub, pericardial effusion (often with leukocyte and protein shift), and elevated inflammatory markers; thought to be caused by autoantibodies against cardiac antigens exposed during the initial injury; distinct from early post-MI pericarditis (peri-infarction pericarditis) which occurs within days.
How It's Used on the Ward
"Dressler's" — the second-wave pericarditis that happens a few weeks after an MI when the patient is home and starts having chest pain again, fever, and a friction rub; immunologic rather than ischemic; less common since reperfusion therapy for STEMI became standard; treated with NSAIDs/colchicine, occasionally corticosteroids.
Example
""64-year-old man, MI 5 weeks ago treated with PCI and DES to LAD, presenting with 3 days of sharp left-sided chest pain worse with inspiration, fever to 38.4°C, and mild dyspnea. Exam: BP 142/86, HR 96, Temp 38.1, lungs clear, cardiac exam shows distant heart sounds and a clear friction rub. ECG: diffuse ST elevation with PR depression (classic pericarditis). Echo: small pericardial effusion without tamponade. Labs: WBC 12.4, ESR 78, CRP 84, troponin undetectable. Diagnosis: Dressler syndrome (post-MI pericarditis at 5 weeks). Started on ibuprofen 600 TID and colchicine 0.6 BID. Effusion monitored; chest pain and fever resolved over 5 days.""
Clinical Context
Timing distinction: (1) Early post-MI pericarditis (peri-infarction pericarditis) within 1–3 days of MI, due to direct myocardial inflammation, less effusion. (2) Dressler syndrome at 2 weeks – several months, immune-mediated, often with effusion and systemic symptoms. Epidemiology: Dressler was much more common in the pre-reperfusion era (~5–10% of MIs); modern era incidence is <1% with routine PCI and dual antiplatelet therapy. Differential: recurrent ischemia (would have troponin elevation and ECG changes consistent with territory), pulmonary embolism, pneumonia, aortic dissection, pleural effusion from other causes. Workup: ECG, troponin (typically negative or low), echo for effusion and tamponade assessment, inflammatory markers (ESR, CRP), chest imaging. Treatment: NSAIDs (ibuprofen, aspirin) + colchicine; corticosteroids if refractory or NSAID-contraindicated; rarely pericardial drainage for large effusions. Distinguish from Dressler from post-cardiotomy syndrome (similar immune pericarditis after cardiac surgery).