Materiały źródłowe

• #1 Post-cardiac injury syndrome: aetiology, diagnosis, and treatment

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

  Post-cardiac injury syndrome (PCIS) refers to an aetiologic heterogenous group of autoimmune-mediated conditions of pericardial, epicardial, and myocardial inflammation. […] Damage to pericardial or pleural mesothelial cells in combination with blood entering the pericardial space represents the initial trigger of PCIS. […] Based on these observations and insights from animal models, we therefore hypothesise that systemic release of cardiac antigens, together with non-specific, injury-mediated activation of the innate immune system initiate adaptive self-antigen specific responses, as evidenced by an increase of antimyocardial antibody titers and expansion of heart-specific CD4 T cells, which in turn promote recruitment of myelo-derived inflammatory cells to the heart. […] Taken together, the latency period between cardiac injury and PCIS, as well as the generally favourable response to anti-inflammatory drugs, both strongly support the hypothesis of an autoimmune-mediated pathogenesis.

• #2 Dressler syndrome – Sparsh Diagnostic Center

  https://www.sparshdiagnostica.com/dressler-syndrome/

  Dressler syndrome is believed to be an autoimmune response to heart injury. […] This autoimmune reaction is thought to be triggered by the release of cardiac antigens into the bloodstream, which the immune system identifies as foreign, thereby initiating an inflammatory response.

• #3 Dressler Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20700

  Dressler syndrome is part of a group of post-cardiac injury syndromes, which include: […] The exact cause of Dressler syndrome is unknown, though it is presumed that an initial injury to mesothelial pericardial cells combined with blood in the pericardial space triggers an immune response and results in an immune complex deposition in the pericardium, pleura, and lungs which causes an inflammatory response. […] The exact cause of Dressler syndrome is unknown, though it is thought to be immune-mediated. Antimyocardial antibodies have been shown to be elevated in the blood of patients with Dressler syndrome. Still, it is unclear whether these antibodies are the cause or occur as a result of the syndrome. These anti-myocardial antibodies are thought to target antigens that have become exposed through damage to the pericardium.

• #4 Post-cardiac injury syndrome: aetiology, diagnosis, and treatment

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

  Post-cardiac injury syndrome (PCIS) refers to an aetiologic heterogenous group of autoimmune-mediated conditions of pericardial, epicardial, and myocardial inflammation. […] Damage to pericardial or pleural mesothelial cells in combination with blood entering the pericardial space represents the initial trigger of PCIS. […] Based on these observations and insights from animal models, we therefore hypothesise that systemic release of cardiac antigens, together with non-specific, injury-mediated activation of the innate immune system initiate adaptive self-antigen specific responses, as evidenced by an increase of antimyocardial antibody titers and expansion of heart-specific CD4 T cells, which in turn promote recruitment of myelo-derived inflammatory cells to the heart. […] Taken together, the latency period between cardiac injury and PCIS, as well as the generally favourable response to anti-inflammatory drugs, both strongly support the hypothesis of an autoimmune-mediated pathogenesis.

• #5 Takotsubo cardiomyopathy complicated by Dressler’s syndrome | The Medical Journal of Australia

  https://www.mja.com.au/journal/2008/188/12/takotsubo-cardiomyopathy-complicated-dresslers-syndrome

  Takotsubo cardiomyopathy is an increasingly recognised syndrome characterised by transient apical left ventricular dysfunction in the absence of significant coronary artery disease. […] The pathogenesis of this condition is not well understood but is postulated to be caused by coronary artery vasospasm in association with intense emotional or physical stress, leading to apical myocardial stunning. […] The role of catecholamines in the pathogenesis of Takotsubo cardiomyopathy has been documented in numerous studies. […] The pathogenesis of Dresslers syndrome is thought to be immune-mediated, as evidenced by late onset of the syndrome. The putative pathogenetic sequence begins with myocardial injury that releases cardiac antigens and stimulates antibody formation. The immune complexes that are generated then deposit onto the pericardium, pleura and lungs, eliciting an inflammatory response.

• #6 Dressler’s syndrome – wikidoc

  https://www.wikidoc.org/index.php/Dressler%27s_syndrome

  Dressler’s syndrome or post-myocardial infarction syndrome is a form of pericarditis that occurs in the setting of myocardial infarction. It typically occurs 2 to 10 weeks after myocardial infarction. Dressler’s syndrome results from an autoimmune inflammatory reaction to myocardial neo-antigens. […] Although the exact cause remains unknown, Dressler’s syndrome is believed to result from an autoimmune inflammatory reaction to myocardial neo-antigens, as well as injury to the mesothelial pericardial cells. […] It usually occurs within weeks or months of the infarction due to antimyocardial antibodies; this begins with myocardial injury that releases cardiac antigens and stimulates antibody formation. […] The immune complexes that are generated as anti-actin and actomyosin antibodies deposit onto the pericardium and causes inflammation. […] The autoimmune response and syndrome may also develop secondary to pulmonary embolism.

• #7 Post-cardiac injury syndrome in the Emergency Department: mini-review

  https://www.immunologyresearchjournal.com/articles/postcardiac-injury-syndrome-in-the-emergency-department-minireview.html

  The PCIS appears to be produced by an initial injury to the myocardium, leading to the release of cardiac antigens that stimulate the immune response. Immune complexes are then generated and deposit in the pericardium, pleura, and lungs, eliciting an inflammatory response. […] The exact pathogenesis of PCIS remains uncertain. PCIS seems to be an autoimmune phenomenon mediated by a combined activation of both cell-mediated and humoral mechanisms. Some observations supporting this association are the latent period between cardiac injury and the onset of PCIS, the correlation between titers of different antibodies (particularly the elevated levels of anti-actin and anti-myosin antibodies) and the clinical occurrence of PCIS and the excellent response to anti-inflammatory therapy. However, the significance of these antibodies and their relation to the severity of myocardial injury is still unclear.

• #8 Pericardial and Pleural Effusions After STEMI

  https://www.acc.org/Education-and-Meetings/Patient-Case-Quizzes/2022/03/07/13/30/Pericardial-and-Pleural-Effusions-After-STEMI

  Dr. William Dressler’s initial descriptions of „The Post Myocardial Infarction (MI) Syndrome” in the late 1950s catalogue a prolonged illness characterized by waxing and waning pleuritic chest pain, fevers, and an evanescent friction rub in the weeks following presentation with MI. The pathophysiology of Dressler syndrome was later elucidated to be autoimmune in nature, driven by an adaptive immune response against cardiac antigens released into the bloodstream during myocardial injury. […] Dressler syndrome is distinct from acute post-infarct pericarditis in its timing; while the former is delayed by weeks after presentation with infarct, the latter occurs within hours to days of MI. The pathophysiology of acute post-infarct pericarditis is less well-defined compared with that of Dressler syndrome.

• #9 Dressler Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20700

  Dressler syndrome is part of a group of post-cardiac injury syndromes, which include: […] The exact cause of Dressler syndrome is unknown, though it is presumed that an initial injury to mesothelial pericardial cells combined with blood in the pericardial space triggers an immune response and results in an immune complex deposition in the pericardium, pleura, and lungs which causes an inflammatory response. […] The exact cause of Dressler syndrome is unknown, though it is thought to be immune-mediated. Antimyocardial antibodies have been shown to be elevated in the blood of patients with Dressler syndrome. Still, it is unclear whether these antibodies are the cause or occur as a result of the syndrome. These anti-myocardial antibodies are thought to target antigens that have become exposed through damage to the pericardium.

• #10 Post-cardiac injury syndrome: aetiology, diagnosis, and treatment

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

  Post-cardiac injury syndrome (PCIS) refers to an aetiologic heterogenous group of autoimmune-mediated conditions of pericardial, epicardial, and myocardial inflammation. […] Damage to pericardial or pleural mesothelial cells in combination with blood entering the pericardial space represents the initial trigger of PCIS. […] Based on these observations and insights from animal models, we therefore hypothesise that systemic release of cardiac antigens, together with non-specific, injury-mediated activation of the innate immune system initiate adaptive self-antigen specific responses, as evidenced by an increase of antimyocardial antibody titers and expansion of heart-specific CD4 T cells, which in turn promote recruitment of myelo-derived inflammatory cells to the heart. […] Taken together, the latency period between cardiac injury and PCIS, as well as the generally favourable response to anti-inflammatory drugs, both strongly support the hypothesis of an autoimmune-mediated pathogenesis.

• #11 Dressler’s Syndrome | Doctor

  https://patient.info/doctor/dresslers-syndrome

  This is a late-onset post-myocardial infarction pericarditis, usually occurring one to six weeks after the initial event, although it can be delayed for as long as three months. […] It is thought to be immune-mediated (anti-myocardial antibodies may be present, although it is not known whether these are the cause of the syndrome or occur as a result of it.1 ). […] It is one of a heterogeneous group of conditions collectively known as post-cardiac injury syndrome (PCIS), which together represent a leading cause of pericarditis.2 PCIS includes Dressler’s syndrome (late-onset pericarditis following myocardial infarction (MI)), early-onset pericarditis following MI, post-cardiotomy syndrome and post-traumatic pericarditis. […] The reduction may be due to the fact that active intervention reduces the size of the infarct and therefore the area of damaged myocardium.

• #12 Dressler Syndrome (Postmyocardial Infarction Syndrome) – MD Searchlight

  https://mdsearchlight.com/heart-health/dressler-syndrome-postmyocardial-infarction-syndrome/

  Dressler syndrome is one of several conditions known as post-cardiac injury syndromes. These conditions are related to various heart problems or treatments involving the heart. […] The precise cause of Dressler syndrome is not clear, but it seems to involve some kind of initial damage to the cells lining the pericardium (the sac around the heart). When there is also blood in the pericardial space (between the sac and the heart), it can trigger an immune response. This leads to an immune reaction in the pericardium, the pleura (the sac that encases the lungs), and the lungs themselves which causes inflammation. […] This theory is backed up by several observations. One is the delay period between the time of the heart injury and the onset of post-cardiac injury syndromes, which can be from a few days to up to 6 weeks post-injury. In some cases, symptoms can even develop a few months after the injury. […] Moreover, patients who have had heart surgery and subsequently developed a post-cardiac injury syndrome often show heightened levels of certain antibodies, which are proteins that fight infections.

• #13 Post-cardiac injury syndrome: aetiology, diagnosis, and treatment

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

  Post-cardiac injury syndrome (PCIS) refers to an aetiologic heterogenous group of autoimmune-mediated conditions of pericardial, epicardial, and myocardial inflammation. […] Damage to pericardial or pleural mesothelial cells in combination with blood entering the pericardial space represents the initial trigger of PCIS. […] Based on these observations and insights from animal models, we therefore hypothesise that systemic release of cardiac antigens, together with non-specific, injury-mediated activation of the innate immune system initiate adaptive self-antigen specific responses, as evidenced by an increase of antimyocardial antibody titers and expansion of heart-specific CD4 T cells, which in turn promote recruitment of myelo-derived inflammatory cells to the heart. […] Taken together, the latency period between cardiac injury and PCIS, as well as the generally favourable response to anti-inflammatory drugs, both strongly support the hypothesis of an autoimmune-mediated pathogenesis.

• #14 Post-cardiac injury syndrome in the Emergency Department: mini-review

  https://www.immunologyresearchjournal.com/articles/postcardiac-injury-syndrome-in-the-emergency-department-minireview.html

  The PCIS appears to be produced by an initial injury to the myocardium, leading to the release of cardiac antigens that stimulate the immune response. Immune complexes are then generated and deposit in the pericardium, pleura, and lungs, eliciting an inflammatory response. […] The exact pathogenesis of PCIS remains uncertain. PCIS seems to be an autoimmune phenomenon mediated by a combined activation of both cell-mediated and humoral mechanisms. Some observations supporting this association are the latent period between cardiac injury and the onset of PCIS, the correlation between titers of different antibodies (particularly the elevated levels of anti-actin and anti-myosin antibodies) and the clinical occurrence of PCIS and the excellent response to anti-inflammatory therapy. However, the significance of these antibodies and their relation to the severity of myocardial injury is still unclear.

• #15 Dressler syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dresslers-syndrome/symptoms-causes/syc-20371811

  Dressler syndrome is swelling and irritation of the sac around the heart that happens after damage to the heart muscle. The damage may trigger an immune system response that causes the condition. The damage can result from a heart attack, heart surgery or a serious injury. […] Experts think Dressler syndrome is caused by the immune system’s response to heart damage. The body reacts to the injured tissue by sending immune cells and proteins called antibodies to clean up and repair the affected area. Sometimes this response causes swelling due to the inflammation in the sac around the heart that’s known as the pericardium. […] Dressler syndrome can happen after a heart attack or some heart surgeries or procedures. It also can happen after a serious injury to the chest, such as trauma from a car accident.

• #16 Dressler syndrome | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/dressler-syndrome?content_id=CON-20371798

  Dressler syndrome is swelling and irritation of the sac around the heart that happens after damage to the heart muscle. The damage may trigger an immune system response that causes the condition. […] Experts think Dressler syndrome is caused by the immune system’s response to heart damage. The body reacts to the injured tissue by sending immune cells and proteins called antibodies to clean up and repair the affected area. Sometimes this response causes swelling due to the inflammation in the sac around the heart that’s known as the pericardium.

• #17 Post-cardiac injury syndrome in the Emergency Department: mini-review

  https://www.immunologyresearchjournal.com/articles/postcardiac-injury-syndrome-in-the-emergency-department-minireview.html

  The PCIS appears to be produced by an initial injury to the myocardium, leading to the release of cardiac antigens that stimulate the immune response. Immune complexes are then generated and deposit in the pericardium, pleura, and lungs, eliciting an inflammatory response. […] The exact pathogenesis of PCIS remains uncertain. PCIS seems to be an autoimmune phenomenon mediated by a combined activation of both cell-mediated and humoral mechanisms. Some observations supporting this association are the latent period between cardiac injury and the onset of PCIS, the correlation between titers of different antibodies (particularly the elevated levels of anti-actin and anti-myosin antibodies) and the clinical occurrence of PCIS and the excellent response to anti-inflammatory therapy. However, the significance of these antibodies and their relation to the severity of myocardial injury is still unclear.

• #18 Post-cardiac injury syndrome: aetiology, diagnosis, and treatment

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

  Post-cardiac injury syndrome (PCIS) refers to an aetiologic heterogenous group of autoimmune-mediated conditions of pericardial, epicardial, and myocardial inflammation. […] Damage to pericardial or pleural mesothelial cells in combination with blood entering the pericardial space represents the initial trigger of PCIS. […] Based on these observations and insights from animal models, we therefore hypothesise that systemic release of cardiac antigens, together with non-specific, injury-mediated activation of the innate immune system initiate adaptive self-antigen specific responses, as evidenced by an increase of antimyocardial antibody titers and expansion of heart-specific CD4 T cells, which in turn promote recruitment of myelo-derived inflammatory cells to the heart. […] Taken together, the latency period between cardiac injury and PCIS, as well as the generally favourable response to anti-inflammatory drugs, both strongly support the hypothesis of an autoimmune-mediated pathogenesis.

• #19 Post-cardiac injury syndrome: aetiology, diagnosis, and treatment

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

  Post-cardiac injury syndrome (PCIS) refers to an aetiologic heterogenous group of autoimmune-mediated conditions of pericardial, epicardial, and myocardial inflammation. […] Damage to pericardial or pleural mesothelial cells in combination with blood entering the pericardial space represents the initial trigger of PCIS. […] Based on these observations and insights from animal models, we therefore hypothesise that systemic release of cardiac antigens, together with non-specific, injury-mediated activation of the innate immune system initiate adaptive self-antigen specific responses, as evidenced by an increase of antimyocardial antibody titers and expansion of heart-specific CD4 T cells, which in turn promote recruitment of myelo-derived inflammatory cells to the heart. […] Taken together, the latency period between cardiac injury and PCIS, as well as the generally favourable response to anti-inflammatory drugs, both strongly support the hypothesis of an autoimmune-mediated pathogenesis.

• #20 Dressler Syndrome (Postmyocardial Infarction Syndrome) – MD Searchlight

  https://mdsearchlight.com/heart-health/dressler-syndrome-postmyocardial-infarction-syndrome/?utm_source=pubmedlink&utm_campaign=MDS&utm_content=20700

  The risk of Dressler syndrome is higher in heart attack patients who’ve had extensive heart tissue damage. […] The incidence of Dressler syndrome seems to be higher during periods when viral infections are more common in the general population. […] Even surgeries that result in minor heart tissue trauma can potentially cause Dressler syndrome. […] The typical treatment is with non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen, which are gradually reduced over 4 to 6 weeks as the fluid around the heart decreases. […] Recurrences of Dressler syndrome are common, and patients may experience symptoms up to a year after the initial event.

• #21 Dressler’s syndrome » Global Autoimmune Institute

  https://www.autoimmuneinstitute.org/autoimmune-resources/autoimmune-diseases-list/dresslers-syndrome/

  Dresslers syndrome is characterized by pericarditis (inflammation of the sac surrounding the heart that occurs after damage to the organ itself or to the pericardium). It is believed to be autoimmune, as evidenced by the presence of myocardial antibodies that could be the cause of inflammation. […] People who have recently suffered a myocardial infarction are at risk of developing Dresslers syndrome. Additional factors linked to the disease include viral infection, recent heart surgery, prior history of pericarditis, prednisone treatment, age, blood type, and exposure to halothane anesthesia.

• #22 Dressler’s syndrome » Global Autoimmune Institute

  https://www.autoimmuneinstitute.org/autoimmune-resources/autoimmune-diseases-list/dresslers-syndrome/

  Dresslers syndrome is characterized by pericarditis (inflammation of the sac surrounding the heart that occurs after damage to the organ itself or to the pericardium). It is believed to be autoimmune, as evidenced by the presence of myocardial antibodies that could be the cause of inflammation. […] People who have recently suffered a myocardial infarction are at risk of developing Dresslers syndrome. Additional factors linked to the disease include viral infection, recent heart surgery, prior history of pericarditis, prednisone treatment, age, blood type, and exposure to halothane anesthesia.

• #23 Complicated Pericarditis: Understanding risk factors and pathophysiology to inform imaging and treatment

  https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/complicated-pericarditis-understanding-risk-factors-and-pathophysiology-to-info

  A separate question relates to the risk of developing a first episode of pericarditis after cardiac injury. In the current era of early reperfusion for acute MI, late pericarditis (Dresslers syndrome) is uncommon (0.5%) (11,12). […] Most cases of recurrent pericarditis with a typical clinical course of severe attacks, with strikingly elevated CRP followed by a prolonged period of quiescence with CRP normalization have probably an autoinflammatory pathogenesis, with unprovoked activation of inflammosome and production of IL1. We now know that colchicine may also inhibits the inflammosome, while anti-IL1 agents may specifically block IL1.

• #24 Dressler’s syndrome demonstrated by late gadolinium enhancement cardiovascular magnetic resonance | Journal of Cardiovascular Magnetic Resonance | Full Text

  https://jcmr-online.biomedcentral.com/articles/10.1186/1532-429X-11-23

  A 49-year old patient presented late with an anterolateral ST-elevation myocardial infarction and was treated with rescue angioplasty to an occluded left anterior descending artery. […] In contrast Dressler’s syndrome presents with a low-grade fever and chest pain 2 to 10 weeks after myocardial infarction, and is less common, affecting between 1 and 5% of patients. […] several possible pathogenic mechanisms have been proposed since including; autosensitisation to myocardial antigens released into the circulation during infarction, latent viruses or simply that the syndrome represents a prolonged and exaggerated form of early post-infarction pericarditis. […] It is postulated that the diminution of the infarct size and the shortened time of exposure of myocardial antigens to the immune system may be responsible. […] This case demonstrates that global pericardial inflammation in Dressler’s syndrome can be clearly visualised by LGE on CMR.

• #25 Dressler Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/20700

  Dressler syndrome is part of a group of post-cardiac injury syndromes, which include: […] The exact cause of Dressler syndrome is unknown, though it is presumed that an initial injury to mesothelial pericardial cells combined with blood in the pericardial space triggers an immune response and results in an immune complex deposition in the pericardium, pleura, and lungs which causes an inflammatory response. […] The exact cause of Dressler syndrome is unknown, though it is thought to be immune-mediated. Antimyocardial antibodies have been shown to be elevated in the blood of patients with Dressler syndrome. Still, it is unclear whether these antibodies are the cause or occur as a result of the syndrome. These anti-myocardial antibodies are thought to target antigens that have become exposed through damage to the pericardium.

• #26 Dressler’s syndrome – wikidoc

  https://www.wikidoc.org/index.php/Dressler%27s_syndrome

  Dressler’s syndrome or post-myocardial infarction syndrome is a form of pericarditis that occurs in the setting of myocardial infarction. It typically occurs 2 to 10 weeks after myocardial infarction. Dressler’s syndrome results from an autoimmune inflammatory reaction to myocardial neo-antigens. […] Although the exact cause remains unknown, Dressler’s syndrome is believed to result from an autoimmune inflammatory reaction to myocardial neo-antigens, as well as injury to the mesothelial pericardial cells. […] It usually occurs within weeks or months of the infarction due to antimyocardial antibodies; this begins with myocardial injury that releases cardiac antigens and stimulates antibody formation. […] The immune complexes that are generated as anti-actin and actomyosin antibodies deposit onto the pericardium and causes inflammation. […] The autoimmune response and syndrome may also develop secondary to pulmonary embolism.

• #27 Dressler’s Syndrome Causes, Symptoms and Treatment

  https://www.netmeds.com/health-library/post/dresslers-syndrome-causes-symptoms-and-treatment?srsltid=AfmBOoqtmOzGK15RqrGuvUOKARm3vB9a30zm8boMTmjvhliUv2xJhFym

  Dresslers syndrome is a type of pericarditis, wherein the sac surrounding the heart, i.e. the pericardium gets inflamed. […] Also referred to as post-myocardial infarction syndrome, post-pericardiotomy syndrome, or post-cardiac injury syndrome since it happens as a sort of excessive immune response by the body after damage to the heart tissue or to the pericardium, from events such as a heart attack (myocardial infarction), heart surgery, heart procedure, or chest trauma due to an accident or injury. […] Although the exact cause of Dressler syndrome isn’t clear, this painful inflamed condition of the heart chiefly occurs as a major immune response to heal the wound and help repair the affected area. But sometimes this response can lead to excessive inflammation in the pericardium. […] When the pericardium becomes inflamed due to the immune response, it can rub against the heart and cause chest pain. […] It can also lead to an excess pericardial fluid build-up in between the layers of the pericardium, putting more pressure on the heart. […] Treatment options usually include anti-inflammatory medications and immuno-suppressants to manage pain and reduce inflammation.

• #28 Pericardial and Pleural Effusions After STEMI

  https://www.acc.org/Education-and-Meetings/Patient-Case-Quizzes/2022/03/07/13/30/Pericardial-and-Pleural-Effusions-After-STEMI

  This case illustrates a typical presentation of Dressler syndrome. Though it is rare, Dressler syndrome is important for the clinician to recognize. This patient’s presentation with enlarging pericardial and pleural effusions 2 weeks after suffering a STEMI is typical for Dressler syndrome. […] The pleural space can be involved in up to 80% of patients with delayed post-infarct pericarditis; typically, these effusions are left-sided, exudative by Light’s criteria, and serosanguineous or hemorrhagic in nature. […] In our patient, no alternative cause was found, so both the pericardial and pleural effusions were caused by Dressler syndrome. […] Typical treatment involves colchicine and non-steroidal anti-inflammatory drugs (NSAIDs). In cases of pericarditis related to coronary pathology, high-dose aspirin is generally favored over ibuprofen or other NSAIDs. Additional agents for pericarditis, including corticosteroids and biologic agents such as anakinra and rilonacept, have not been studied in post-infarct pericarditis or Dressler syndrome.

• #29 Pericardial and Pleural Effusions After STEMI

  https://www.acc.org/Education-and-Meetings/Patient-Case-Quizzes/2022/03/07/13/30/Pericardial-and-Pleural-Effusions-After-STEMI

  This case illustrates a typical presentation of Dressler syndrome. Though it is rare, Dressler syndrome is important for the clinician to recognize. This patient’s presentation with enlarging pericardial and pleural effusions 2 weeks after suffering a STEMI is typical for Dressler syndrome. […] The pleural space can be involved in up to 80% of patients with delayed post-infarct pericarditis; typically, these effusions are left-sided, exudative by Light’s criteria, and serosanguineous or hemorrhagic in nature. […] In our patient, no alternative cause was found, so both the pericardial and pleural effusions were caused by Dressler syndrome. […] Typical treatment involves colchicine and non-steroidal anti-inflammatory drugs (NSAIDs). In cases of pericarditis related to coronary pathology, high-dose aspirin is generally favored over ibuprofen or other NSAIDs. Additional agents for pericarditis, including corticosteroids and biologic agents such as anakinra and rilonacept, have not been studied in post-infarct pericarditis or Dressler syndrome.

• #30 Dressler Syndrome: Causes, Diagnosis, and Treatment

  https://www.healthline.com/health/dressler-syndrome

  Dressler syndrome is thought to occur when the immune system responds excessively following one of these events. […] The exact cause of Dressler syndrome isn’t clear. It’s believed to occur when a heart surgery or heart attack triggers an immune response in the pericardium. In response to an injury, the body typically sends immune cells and antibodies to help repair the area. But an immune response can sometimes cause an excessive amount of inflammation. […] The immune response that causes Dressler syndrome may also cause a condition known as pleural effusion. This is when fluid accumulates in the membranes around your lungs. […] Chronic inflammation in the heart can also lead to constrictive pericarditis. This is when the pericardium becomes thick or scarred due to long-term inflammation.

• #31 Complicated Pericarditis: Understanding risk factors and pathophysiology to inform imaging and treatment

  https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/complicated-pericarditis-understanding-risk-factors-and-pathophysiology-to-info

  A separate question relates to the risk of developing a first episode of pericarditis after cardiac injury. In the current era of early reperfusion for acute MI, late pericarditis (Dresslers syndrome) is uncommon (0.5%) (11,12). […] Most cases of recurrent pericarditis with a typical clinical course of severe attacks, with strikingly elevated CRP followed by a prolonged period of quiescence with CRP normalization have probably an autoinflammatory pathogenesis, with unprovoked activation of inflammosome and production of IL1. We now know that colchicine may also inhibits the inflammosome, while anti-IL1 agents may specifically block IL1.

• #32 Complicated Pericarditis: Understanding risk factors and pathophysiology to inform imaging and treatment

  https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/complicated-pericarditis-understanding-risk-factors-and-pathophysiology-to-info

  A separate question relates to the risk of developing a first episode of pericarditis after cardiac injury. In the current era of early reperfusion for acute MI, late pericarditis (Dresslers syndrome) is uncommon (0.5%) (11,12). […] Most cases of recurrent pericarditis with a typical clinical course of severe attacks, with strikingly elevated CRP followed by a prolonged period of quiescence with CRP normalization have probably an autoinflammatory pathogenesis, with unprovoked activation of inflammosome and production of IL1. We now know that colchicine may also inhibits the inflammosome, while anti-IL1 agents may specifically block IL1.

• #33 – MedCrave online

  https://medcraveonline.com/MOJCR/MOJCR-02-00028

  However, an immune mediated inflammatory response to initial cardiac injury triggered by pacemaker lead may play a role on the pathogenesis of this syndrome. […] Early diagnosis of pacemaker induced PCIS is very important as most of these patients respond well to medical treatment with NSAID, colchicine and/or steroids. […] Although PCIS typically has a benign course, it may result in significant morbidity and mortality due to cardiac tamponade, arrhythmias and pulmonary edema. […] Although PCIS responds well to anti-inflammatory agents and has favorable prognosis, delayed diagnosis may result in potential serious complications such as cardiac tamponade. Therefore, its early detection is of clinical importance.

• #34 Dressler’s syndrome: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/dresslers-syndrome

  Dresslers syndrome is a rare but treatable type of inflammation in the sac surrounding the heart. […] However, Dresslers syndrome is an extremely rare type of pericarditis that usually develops after a heart injury. It might occur due to immune activity that causes inflammation after a heart injury by responding excessively. […] The direct cause of Dresslers syndrome is unclear. According to the Autoimmune Association, damaged heart tissue releases proteins that may signal to the immune system that repair is necessary in the area. This immune response might lead to inflammation in the pericardium. […] While Dresslers syndrome is rare, it can lead to severe complications. These might include cardiac tamponade and constrictive pericarditis. […] To help with a further evaluation, a doctor will likely check for Dresslers syndrome in any individuals who present with fatigue 2 weeks after a heart attack. […] Treatment often involves nonsteroidal or steroidal anti-inflammatory medications. However, if complications such as cardiac tamponade or constrictive pericarditis develop, the doctor might consider pericardiocentesis.

• #35 – MedCrave online

  https://medcraveonline.com/MOJCR/MOJCR-02-00028

  However, an immune mediated inflammatory response to initial cardiac injury triggered by pacemaker lead may play a role on the pathogenesis of this syndrome. […] Early diagnosis of pacemaker induced PCIS is very important as most of these patients respond well to medical treatment with NSAID, colchicine and/or steroids. […] Although PCIS typically has a benign course, it may result in significant morbidity and mortality due to cardiac tamponade, arrhythmias and pulmonary edema. […] Although PCIS responds well to anti-inflammatory agents and has favorable prognosis, delayed diagnosis may result in potential serious complications such as cardiac tamponade. Therefore, its early detection is of clinical importance.

• #36 Pericarditis – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/myocarditis-and-pericarditis/pericarditis

  Acute myocardial infarction causes 7 to 12% of cases of acute pericarditis (1). […] Post-myocardial infarction syndrome (Dressler syndrome) is a less common cause, occurring mainly when reperfusion with percutaneous transluminal coronary angioplasty (PTCA) or thrombolytic drugs is ineffective in patients with transmural infarction (2). […] Occasionally, pericarditis causes a marked thickening and stiffening of the pericardium (constrictive pericarditis). […] Constrictive pericarditis, which is now less common than in the past, results from marked inflammatory, fibrotic thickening of the pericardium. […] The stiff, thickened pericardium markedly impairs ventricular filling, decreasing stroke volume and cardiac output. […] Chronic constrictive pericarditis, usually requiring pericardiectomy as definitive treatment

• #37 Pericarditis – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/myocarditis-and-pericarditis/pericarditis

  Acute myocardial infarction causes 7 to 12% of cases of acute pericarditis (1). […] Post-myocardial infarction syndrome (Dressler syndrome) is a less common cause, occurring mainly when reperfusion with percutaneous transluminal coronary angioplasty (PTCA) or thrombolytic drugs is ineffective in patients with transmural infarction (2). […] Occasionally, pericarditis causes a marked thickening and stiffening of the pericardium (constrictive pericarditis). […] Constrictive pericarditis, which is now less common than in the past, results from marked inflammatory, fibrotic thickening of the pericardium. […] The stiff, thickened pericardium markedly impairs ventricular filling, decreasing stroke volume and cardiac output. […] Chronic constrictive pericarditis, usually requiring pericardiectomy as definitive treatment

• #38 Pericarditis & Constrictive Pericarditis – Free Sketchy Medical Lesson

  https://www.sketchy.com/medical-lessons/pericarditis-constrictive-pericarditis

  Myocardial infarction (MI) can lead to two forms of pericarditis: an initial inflammatory type immediately after the event, and a delayed autoimmune variant known as Dressler syndrome appearing 2-4 weeks later. […] Constrictive pericarditis is a consequence of scarring and fibrosis of the pericardium, often subsequent to a previous episode of pericarditis. This results in a rigid, non-distensible pericardium that restricts diastolic expansion of the heart.

• #39 – MedCrave online

  https://medcraveonline.com/MOJCR/MOJCR-02-00028

  Post cardiac injury syndrome (PCIS) is a well-recognized clinical entity. PCIS is an inflammatory pericarditis that develops a few weeks after a cardiac injury. It usually presents following myocardial infarction (Dressler syndrome), cardiac surgery or trauma. […] The mechanism of PCIS is still not well understood. However, an immune mediated inflammatory response to initial cardiac injury may play a role in the pathogenesis of this syndrome. […] Dresslers syndrome following myocardial infarction is the prototype of PCIS. However, it can also occur after cardiac surgery (post-pericardiotomy syndrome), cardiac trauma (post-traumatic pericarditis) or rarely post pacemaker implantation (post-pacemaker insertion pericarditis). […] The mechanism of PCIS in general and post pacemaker insertion pericarditis in particular is still not well understood.

• #40 Dressler syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/dressler-syndrome-1?embed_domain=hackmd.io%2F%40yipuafecsl2jsu8smr5njq%2Fbnjhjgjghjghjghfavicon.icofavicon.ico&lang=us

  Dressler syndrome (DS) is a delayed immune-mediated or secondary pericarditis developing weeks to months after a myocardial infarction (MI). […] The etiology is not well understood, and several possible pathomechanisms have been proposed, including local inflammation, autoimmune response, and latent viruses. There is a consensus that Dressler syndrome shares similarities with other entities seen after myocardial damage, including postcardiotomy syndrome and posttraumatic pericarditis. […] Dressler syndrome is most likely immunomodulated. […] It is most commonly seen after transmural infarction; however, it may also be seen in milder forms of myocardial infarction.

• #41 Understanding Dressler’s Syndrome: Causes, Symptoms & Treatment – The Kingsley Clinic

  https://thekingsleyclinic.com/resources/understanding-dresslers-syndrome-causes-symptoms-treatment/

  Dressler’s syndrome is a type of pericarditis, which refers to inflammation of the pericardium—the thin, sac-like membrane that encases the heart. This condition is believed to be an autoimmune response, where the immune system mistakenly attacks the body’s own tissues following damage to the heart. It typically develops weeks to months after events such as a heart attack, cardiac surgery, or chest trauma. […] Research suggests it occurs in approximately 1-5% of patients following a heart attack or cardiac surgery. […] Dressler’s syndrome is a serious condition that requires prompt recognition. Identifying symptoms early and seeking timely medical care can significantly improve outcomes and help prevent complications.

• #42 Complicated Pericarditis: Understanding risk factors and pathophysiology to inform imaging and treatment

  https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/complicated-pericarditis-understanding-risk-factors-and-pathophysiology-to-info

  A separate question relates to the risk of developing a first episode of pericarditis after cardiac injury. In the current era of early reperfusion for acute MI, late pericarditis (Dresslers syndrome) is uncommon (0.5%) (11,12). […] Most cases of recurrent pericarditis with a typical clinical course of severe attacks, with strikingly elevated CRP followed by a prolonged period of quiescence with CRP normalization have probably an autoinflammatory pathogenesis, with unprovoked activation of inflammosome and production of IL1. We now know that colchicine may also inhibits the inflammosome, while anti-IL1 agents may specifically block IL1.

• #43 Post-myocardial infarction (Dressler’s) syndrome following early reperfusion – The British Journal of Cardiology

  https://bjcardio.co.uk/2012/05/post-myocardial-infarction-dresslers-syndrome-following-early-reperfusion/

  We present a case of a 55-year-old female with a successfully reperfused myocardial infarction in whom Dresslers syndrome was subsequently diagnosed. […] In conclusion, this case demonstrates that this syndrome is still a possibility in the current realm of thrombolysis and cardiac catheterisation. […] Dresslers, or post-cardiac injury, syndrome is a well-recognised complication of myocardial infarction; however, following the introduction of thrombolysis and cardiac catheterisation its continued existence in the era of reperfusion has been questioned. […] This demonstrates that despite the advances in medical care Dresslers syndrome continues to exist and should be considered in the differential of anyone presenting with chest pain in the setting of a recent myocardial infarction. […] While the exact mechanism has yet to be elucidated, it has been postulated to be an immune mechanism given the presence of the latency period, its correlation to actin and myosin antibody titres and its excellent response to anti-inflammatory agents. […] Essentially, this case serves as a reminder that Dresslers syndrome is a potential complication following a myocardial infarction, even in the era of reperfusion and with recent advances in medical care. […] To date, there has been no reported case of Dresslers syndrome following documented early reperfusion of a myocardial infarction. […] The presented case demonstrates that early reperfusion does not prevent this syndrome from occurring.

• #44 Dressler’s Syndrome: Causes, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/17947-dresslers-syndrome

  Dresslers syndrome is a kind of pericarditis, or inflammation of the sac around the outside of your heart. A heart attack or other type of heart damage may set off an immune system reaction that leads to Dresslers syndrome. […] Dresslers syndrome is a form of pericarditis, or inflammation of the pericardium, a tough elastic sac that surrounds your heart. This may happen when your immune system reacts after some type of damage to your heart. […] Healthcare experts dont know the exact cause of Dresslers syndrome. They believe its the result of an immune system response following injury or damage to the cells of your heart or pericardium. […] Possible Dresslers syndrome causes include: Heart attack (myocardial infarction). Heart surgery. Invasive procedures, such as cardiac ablation or implantation of a pacemaker. Chest injury or trauma.

• #45 – MedCrave online

  https://medcraveonline.com/MOJCR/MOJCR-02-00028

  Post cardiac injury syndrome (PCIS) is a well-recognized clinical entity. PCIS is an inflammatory pericarditis that develops a few weeks after a cardiac injury. It usually presents following myocardial infarction (Dressler syndrome), cardiac surgery or trauma. […] The mechanism of PCIS is still not well understood. However, an immune mediated inflammatory response to initial cardiac injury may play a role in the pathogenesis of this syndrome. […] Dresslers syndrome following myocardial infarction is the prototype of PCIS. However, it can also occur after cardiac surgery (post-pericardiotomy syndrome), cardiac trauma (post-traumatic pericarditis) or rarely post pacemaker implantation (post-pacemaker insertion pericarditis). […] The mechanism of PCIS in general and post pacemaker insertion pericarditis in particular is still not well understood.

• #46 43 Dressler’s syndrome post left atrial appendage occlusion: a rare diagnoses resurfaces | Heart

  https://heart.bmj.com/content/108/Suppl_3/A36

  Dresslers Syndrome also known as post myocardial infarction syndrome is a secondary pericarditis that can occur after cardiac myocyte damage. Such damage can occur after a myocardial infarction or routine endovascular surgery. […] DS is a rare complication of the LAAO procedure with one study documenting a 1% incidence. Along with one case report highlighting DS as a complication post ligation of the left atrial appendage with a LARIAT suture. […] The association of DS as a complication post LAAO is exceptionally rare. Its uniqueness may be attributable to several causal factors including its ability to mimic more common conditions, along with its declining incidence via improved revascularisation techniques.

• #47 DRESSLER SYNDROME: A EMERGING COMPLICATION OF ABLATIVE THERAPY FOR ATRIAL FIBRILLATION. – SHM Abstracts | Society of Hospital Medicine

  https://shmabstracts.mystagingwebsite.com/abstract/dressler-syndrome-a-emerging-complication-of-ablative-therapy-for-atrial-fibrillation/

  Dressler syndrome is a form of post cardiac injury syndrome presenting with pleuritic chest pain, low grade fevers, and mild pericardial effusions. […] The mechanism of injury remains poorly understood, but it is thought to be a result of antibodies after myocardial injury. […] Prompt diagnosis of this syndrome is essential as the treatment is simple with anti-inflammatory drugs such as steroids and colchicine.

• #48 – MedCrave online

  https://medcraveonline.com/MOJCR/MOJCR-02-00028

  Post cardiac injury syndrome (PCIS) is a well-recognized clinical entity. PCIS is an inflammatory pericarditis that develops a few weeks after a cardiac injury. It usually presents following myocardial infarction (Dressler syndrome), cardiac surgery or trauma. […] The mechanism of PCIS is still not well understood. However, an immune mediated inflammatory response to initial cardiac injury may play a role in the pathogenesis of this syndrome. […] Dresslers syndrome following myocardial infarction is the prototype of PCIS. However, it can also occur after cardiac surgery (post-pericardiotomy syndrome), cardiac trauma (post-traumatic pericarditis) or rarely post pacemaker implantation (post-pacemaker insertion pericarditis). […] The mechanism of PCIS in general and post pacemaker insertion pericarditis in particular is still not well understood.

• #49 Dressler syndrome – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dresslers-syndrome/symptoms-causes/syc-20371811

  Dressler syndrome is swelling and irritation of the sac around the heart that happens after damage to the heart muscle. The damage may trigger an immune system response that causes the condition. The damage can result from a heart attack, heart surgery or a serious injury. […] Experts think Dressler syndrome is caused by the immune system’s response to heart damage. The body reacts to the injured tissue by sending immune cells and proteins called antibodies to clean up and repair the affected area. Sometimes this response causes swelling due to the inflammation in the sac around the heart that’s known as the pericardium. […] Dressler syndrome can happen after a heart attack or some heart surgeries or procedures. It also can happen after a serious injury to the chest, such as trauma from a car accident.

• #50 Mayo Clinic Health Library – Dressler syndrome | Swiss Medical Network

  https://www.swissmedical.net/fr/healtcare-library/con-20371798

  Dressler syndrome is swelling and irritation of the sac around the heart that happens after damage to the heart muscle. […] Experts think Dressler syndrome is caused by the immune system’s response to heart damage. The body reacts to the injured tissue by sending immune cells and proteins called antibodies to clean up and repair the affected area. Sometimes this response causes swelling due to the inflammation in the sac around the heart that’s known as the pericardium. […] Dressler syndrome can happen after a heart attack or some heart surgeries or procedures. It also can happen after a serious injury to the chest, such as trauma from a car accident.

• #51 Dressler syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/dressler-syndrome-1?lang=us

  Dressler syndrome (DS) is a delayed immune-mediated or secondary pericarditis developing weeks to months after a myocardial infarction (MI). […] The etiology is not well understood, and several possible pathomechanisms have been proposed, including local inflammation, autoimmune response, and latent viruses. There is a consensus that Dressler syndrome is most likely immunomodulated. […] Dressler syndrome shares similarities with other entities seen after myocardial damage, including postcardiotomy syndrome and posttraumatic pericarditis.

• #52 Takotsubo cardiomyopathy complicated by Dressler’s syndrome | The Medical Journal of Australia

  https://www.mja.com.au/journal/2008/188/12/takotsubo-cardiomyopathy-complicated-dresslers-syndrome

  Our patient presented with Takotsubo cardiomyopathy and developed Dresslers syndrome 6 weeks later. To our knowledge, Dresslers syndrome following Takotsubo cardiomyopathy has not been previously described in the literature. This may be because the extent of biochemical myocardial damage demonstrated is often small in Takotsubo cardiomyopathy, whereas Dresslers syndrome is often associated with significant myocardial necrosis. For this reason, the diagnosis of Dresslers syndrome in our patient was unexpected and the mechanism is unclear.

• #53 Dressler’s syndrome – wikidoc

  https://www.wikidoc.org/index.php/Dressler%27s_syndrome

  Dressler’s syndrome or post-myocardial infarction syndrome is a form of pericarditis that occurs in the setting of myocardial infarction. It typically occurs 2 to 10 weeks after myocardial infarction. Dressler’s syndrome results from an autoimmune inflammatory reaction to myocardial neo-antigens. […] Although the exact cause remains unknown, Dressler’s syndrome is believed to result from an autoimmune inflammatory reaction to myocardial neo-antigens, as well as injury to the mesothelial pericardial cells. […] It usually occurs within weeks or months of the infarction due to antimyocardial antibodies; this begins with myocardial injury that releases cardiac antigens and stimulates antibody formation. […] The immune complexes that are generated as anti-actin and actomyosin antibodies deposit onto the pericardium and causes inflammation. […] The autoimmune response and syndrome may also develop secondary to pulmonary embolism.

• #54 Dressler syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/dressler-syndrome-1?lang=us

  Dressler syndrome (DS) is a delayed immune-mediated or secondary pericarditis developing weeks to months after a myocardial infarction (MI). […] The etiology is not well understood, and several possible pathomechanisms have been proposed, including local inflammation, autoimmune response, and latent viruses. There is a consensus that Dressler syndrome is most likely immunomodulated. […] Dressler syndrome shares similarities with other entities seen after myocardial damage, including postcardiotomy syndrome and posttraumatic pericarditis.

• #55 LearningRadiology – Postpericardiotomy, Syndrome, Dressler’s

  http://learningradiology.com/archives2011/COW%20464-PPS/ppscorrect.htm

  Autoimmune and febrile illness that can follow coronary artery bypass surgery […] May also be seen following myocardial infarction (Dresslers syndrome) […] Believed to have immunologic cause […] Possibly a latent viral infection may be involved in cause.

• #56 Dressler Syndrome: Not Just a Relic of the Past

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9681686/

  Dressler syndrome, also known as post-myocardial infarction syndrome, is a condition in which sterile pericarditis develops shortly after myocardial injury. […] While several pathologic mechanisms have been proposed, there is consensus that this syndrome develops at least in part via activation of the immune system in response to myocardial damage leading to immunologic cross-reactivity and pericarditis. It is felt that tissue infarction causes release of intracellular components leading to auto-antibody production against myocardial and pericardial tissue. […] Importantly for clinicians, this triad has very poor sensitivity and is present in only a minority of patients. […] To increase prompt diagnoses of post-MI syndrome, clinicians should maintain a degree of suspicion for any patient presenting with new chest pain, fatigue, or signs/symptoms of active inflammation after sustaining MI. Additional lab tests to evaluate inflammation such as the erythrocyte sedimentation rate or c-reactive protein can play an important role in securing a diagnosis. TTE is also recommended to evaluate for pericardial effusion and to rule out any objective evidence for hemodynamically significant effusion or other structural pathology. Once post-MI syndrome is confirmed or strongly suspected, treatment with colchicine and high-dose non-steroidal anti-inflammatory agents such as aspirin or indomethacin should be considered to prevent refractory symptoms.

• #57 Pericardial and Pleural Effusions After STEMI

  https://www.acc.org/Education-and-Meetings/Patient-Case-Quizzes/2022/03/07/13/30/Pericardial-and-Pleural-Effusions-After-STEMI

  Dr. William Dressler’s initial descriptions of „The Post Myocardial Infarction (MI) Syndrome” in the late 1950s catalogue a prolonged illness characterized by waxing and waning pleuritic chest pain, fevers, and an evanescent friction rub in the weeks following presentation with MI. The pathophysiology of Dressler syndrome was later elucidated to be autoimmune in nature, driven by an adaptive immune response against cardiac antigens released into the bloodstream during myocardial injury. […] Dressler syndrome is distinct from acute post-infarct pericarditis in its timing; while the former is delayed by weeks after presentation with infarct, the latter occurs within hours to days of MI. The pathophysiology of acute post-infarct pericarditis is less well-defined compared with that of Dressler syndrome.

• #58 Pericardial and Pleural Effusions After STEMI

  https://www.acc.org/Education-and-Meetings/Patient-Case-Quizzes/2022/03/07/13/30/Pericardial-and-Pleural-Effusions-After-STEMI

  This case illustrates a typical presentation of Dressler syndrome. Though it is rare, Dressler syndrome is important for the clinician to recognize. This patient’s presentation with enlarging pericardial and pleural effusions 2 weeks after suffering a STEMI is typical for Dressler syndrome. […] The pleural space can be involved in up to 80% of patients with delayed post-infarct pericarditis; typically, these effusions are left-sided, exudative by Light’s criteria, and serosanguineous or hemorrhagic in nature. […] In our patient, no alternative cause was found, so both the pericardial and pleural effusions were caused by Dressler syndrome. […] Typical treatment involves colchicine and non-steroidal anti-inflammatory drugs (NSAIDs). In cases of pericarditis related to coronary pathology, high-dose aspirin is generally favored over ibuprofen or other NSAIDs. Additional agents for pericarditis, including corticosteroids and biologic agents such as anakinra and rilonacept, have not been studied in post-infarct pericarditis or Dressler syndrome.

• #59 Dressler Syndrome: Not Just a Relic of the Past

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9681686/

  Dressler syndrome, also known as post-myocardial infarction syndrome, is a condition in which sterile pericarditis develops shortly after myocardial injury. […] While several pathologic mechanisms have been proposed, there is consensus that this syndrome develops at least in part via activation of the immune system in response to myocardial damage leading to immunologic cross-reactivity and pericarditis. It is felt that tissue infarction causes release of intracellular components leading to auto-antibody production against myocardial and pericardial tissue. […] Importantly for clinicians, this triad has very poor sensitivity and is present in only a minority of patients. […] To increase prompt diagnoses of post-MI syndrome, clinicians should maintain a degree of suspicion for any patient presenting with new chest pain, fatigue, or signs/symptoms of active inflammation after sustaining MI. Additional lab tests to evaluate inflammation such as the erythrocyte sedimentation rate or c-reactive protein can play an important role in securing a diagnosis. TTE is also recommended to evaluate for pericardial effusion and to rule out any objective evidence for hemodynamically significant effusion or other structural pathology. Once post-MI syndrome is confirmed or strongly suspected, treatment with colchicine and high-dose non-steroidal anti-inflammatory agents such as aspirin or indomethacin should be considered to prevent refractory symptoms.

• #60 Dressler Syndrome: Not Just a Relic of the Past

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9681686/

  Dressler syndrome, also known as post-myocardial infarction syndrome, is a condition in which sterile pericarditis develops shortly after myocardial injury. […] While several pathologic mechanisms have been proposed, there is consensus that this syndrome develops at least in part via activation of the immune system in response to myocardial damage leading to immunologic cross-reactivity and pericarditis. It is felt that tissue infarction causes release of intracellular components leading to auto-antibody production against myocardial and pericardial tissue. […] Importantly for clinicians, this triad has very poor sensitivity and is present in only a minority of patients. […] To increase prompt diagnoses of post-MI syndrome, clinicians should maintain a degree of suspicion for any patient presenting with new chest pain, fatigue, or signs/symptoms of active inflammation after sustaining MI. Additional lab tests to evaluate inflammation such as the erythrocyte sedimentation rate or c-reactive protein can play an important role in securing a diagnosis. TTE is also recommended to evaluate for pericardial effusion and to rule out any objective evidence for hemodynamically significant effusion or other structural pathology. Once post-MI syndrome is confirmed or strongly suspected, treatment with colchicine and high-dose non-steroidal anti-inflammatory agents such as aspirin or indomethacin should be considered to prevent refractory symptoms.

• #61 Dressler Syndrome: Not Just a Relic of the Past

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9681686/

  Dressler syndrome, also known as post-myocardial infarction syndrome, is a condition in which sterile pericarditis develops shortly after myocardial injury. […] While several pathologic mechanisms have been proposed, there is consensus that this syndrome develops at least in part via activation of the immune system in response to myocardial damage leading to immunologic cross-reactivity and pericarditis. It is felt that tissue infarction causes release of intracellular components leading to auto-antibody production against myocardial and pericardial tissue. […] Importantly for clinicians, this triad has very poor sensitivity and is present in only a minority of patients. […] To increase prompt diagnoses of post-MI syndrome, clinicians should maintain a degree of suspicion for any patient presenting with new chest pain, fatigue, or signs/symptoms of active inflammation after sustaining MI. Additional lab tests to evaluate inflammation such as the erythrocyte sedimentation rate or c-reactive protein can play an important role in securing a diagnosis. TTE is also recommended to evaluate for pericardial effusion and to rule out any objective evidence for hemodynamically significant effusion or other structural pathology. Once post-MI syndrome is confirmed or strongly suspected, treatment with colchicine and high-dose non-steroidal anti-inflammatory agents such as aspirin or indomethacin should be considered to prevent refractory symptoms.

• #62 Pericardial and Pleural Effusions After STEMI

  https://www.acc.org/Education-and-Meetings/Patient-Case-Quizzes/2022/03/07/13/30/Pericardial-and-Pleural-Effusions-After-STEMI

  This case illustrates a typical presentation of Dressler syndrome. Though it is rare, Dressler syndrome is important for the clinician to recognize. This patient’s presentation with enlarging pericardial and pleural effusions 2 weeks after suffering a STEMI is typical for Dressler syndrome. […] The pleural space can be involved in up to 80% of patients with delayed post-infarct pericarditis; typically, these effusions are left-sided, exudative by Light’s criteria, and serosanguineous or hemorrhagic in nature. […] In our patient, no alternative cause was found, so both the pericardial and pleural effusions were caused by Dressler syndrome. […] Typical treatment involves colchicine and non-steroidal anti-inflammatory drugs (NSAIDs). In cases of pericarditis related to coronary pathology, high-dose aspirin is generally favored over ibuprofen or other NSAIDs. Additional agents for pericarditis, including corticosteroids and biologic agents such as anakinra and rilonacept, have not been studied in post-infarct pericarditis or Dressler syndrome.

• #63 Post-cardiac injury syndrome: aetiology, diagnosis, and treatment

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Post-cardiac-injury-syndrome-aetiology-diagnosis-and-treatment

  Post-cardiac injury syndrome (PCIS) refers to an aetiologic heterogenous group of autoimmune-mediated conditions of pericardial, epicardial, and myocardial inflammation. […] Damage to pericardial or pleural mesothelial cells in combination with blood entering the pericardial space represents the initial trigger of PCIS. […] Based on these observations and insights from animal models, we therefore hypothesise that systemic release of cardiac antigens, together with non-specific, injury-mediated activation of the innate immune system initiate adaptive self-antigen specific responses, as evidenced by an increase of antimyocardial antibody titers and expansion of heart-specific CD4 T cells, which in turn promote recruitment of myelo-derived inflammatory cells to the heart. […] Taken together, the latency period between cardiac injury and PCIS, as well as the generally favourable response to anti-inflammatory drugs, both strongly support the hypothesis of an autoimmune-mediated pathogenesis.

• #64 Post-cardiac injury syndrome in the Emergency Department: mini-review

  https://www.immunologyresearchjournal.com/articles/postcardiac-injury-syndrome-in-the-emergency-department-minireview.html

  The PCIS appears to be produced by an initial injury to the myocardium, leading to the release of cardiac antigens that stimulate the immune response. Immune complexes are then generated and deposit in the pericardium, pleura, and lungs, eliciting an inflammatory response. […] The exact pathogenesis of PCIS remains uncertain. PCIS seems to be an autoimmune phenomenon mediated by a combined activation of both cell-mediated and humoral mechanisms. Some observations supporting this association are the latent period between cardiac injury and the onset of PCIS, the correlation between titers of different antibodies (particularly the elevated levels of anti-actin and anti-myosin antibodies) and the clinical occurrence of PCIS and the excellent response to anti-inflammatory therapy. However, the significance of these antibodies and their relation to the severity of myocardial injury is still unclear.

• #65 Dressler Syndrome (Postmyocardial Infarction Syndrome) – MD Searchlight

  https://mdsearchlight.com/heart-health/dressler-syndrome-postmyocardial-infarction-syndrome/?utm_source=pubmedlink&utm_campaign=MDS&utm_content=20700

  The risk of Dressler syndrome is higher in heart attack patients who’ve had extensive heart tissue damage. […] The incidence of Dressler syndrome seems to be higher during periods when viral infections are more common in the general population. […] Even surgeries that result in minor heart tissue trauma can potentially cause Dressler syndrome. […] The typical treatment is with non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen, which are gradually reduced over 4 to 6 weeks as the fluid around the heart decreases. […] Recurrences of Dressler syndrome are common, and patients may experience symptoms up to a year after the initial event.

• #66 DRESSLER SYNDROME: A EMERGING COMPLICATION OF ABLATIVE THERAPY FOR ATRIAL FIBRILLATION. – SHM Abstracts | Society of Hospital Medicine

  https://shmabstracts.mystagingwebsite.com/abstract/dressler-syndrome-a-emerging-complication-of-ablative-therapy-for-atrial-fibrillation/

  Dressler syndrome is a form of post cardiac injury syndrome presenting with pleuritic chest pain, low grade fevers, and mild pericardial effusions. […] The mechanism of injury remains poorly understood, but it is thought to be a result of antibodies after myocardial injury. […] Prompt diagnosis of this syndrome is essential as the treatment is simple with anti-inflammatory drugs such as steroids and colchicine.

• #67 Dressler’s syndrome: Causes, symptoms, and treatments

  https://www.medicalnewstoday.com/articles/dresslers-syndrome

  Dresslers syndrome is a rare but treatable type of inflammation in the sac surrounding the heart. […] However, Dresslers syndrome is an extremely rare type of pericarditis that usually develops after a heart injury. It might occur due to immune activity that causes inflammation after a heart injury by responding excessively. […] The direct cause of Dresslers syndrome is unclear. According to the Autoimmune Association, damaged heart tissue releases proteins that may signal to the immune system that repair is necessary in the area. This immune response might lead to inflammation in the pericardium. […] While Dresslers syndrome is rare, it can lead to severe complications. These might include cardiac tamponade and constrictive pericarditis. […] To help with a further evaluation, a doctor will likely check for Dresslers syndrome in any individuals who present with fatigue 2 weeks after a heart attack. […] Treatment often involves nonsteroidal or steroidal anti-inflammatory medications. However, if complications such as cardiac tamponade or constrictive pericarditis develop, the doctor might consider pericardiocentesis.

• #68 – MedCrave online

  https://medcraveonline.com/MOJCR/MOJCR-02-00028

  However, an immune mediated inflammatory response to initial cardiac injury triggered by pacemaker lead may play a role on the pathogenesis of this syndrome. […] Early diagnosis of pacemaker induced PCIS is very important as most of these patients respond well to medical treatment with NSAID, colchicine and/or steroids. […] Although PCIS typically has a benign course, it may result in significant morbidity and mortality due to cardiac tamponade, arrhythmias and pulmonary edema. […] Although PCIS responds well to anti-inflammatory agents and has favorable prognosis, delayed diagnosis may result in potential serious complications such as cardiac tamponade. Therefore, its early detection is of clinical importance.

• #69 Dressler’s Syndrome | Doctor

  https://patient.info/doctor/dresslers-syndrome

  It can follow a relapsing course but the outcome is usually favourable, depending on the nature and severity of co-existing heart disease. Response to treatment is generally good within two weeks. […] Prevention is no longer needed now that modern management of myocardial infarction has resulted in a reduction in the incidence of this syndrome.

• #70 Dressler Syndrome (Postmyocardial Infarction Syndrome) – MD Searchlight

  https://mdsearchlight.com/heart-health/dressler-syndrome-postmyocardial-infarction-syndrome/?utm_source=pubmedlink&utm_campaign=MDS&utm_content=20700

  The risk of Dressler syndrome is higher in heart attack patients who’ve had extensive heart tissue damage. […] The incidence of Dressler syndrome seems to be higher during periods when viral infections are more common in the general population. […] Even surgeries that result in minor heart tissue trauma can potentially cause Dressler syndrome. […] The typical treatment is with non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen, which are gradually reduced over 4 to 6 weeks as the fluid around the heart decreases. […] Recurrences of Dressler syndrome are common, and patients may experience symptoms up to a year after the initial event.

• #71 Complicated Pericarditis: Understanding risk factors and pathophysiology to inform imaging and treatment

  https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/complicated-pericarditis-understanding-risk-factors-and-pathophysiology-to-info

  A separate question relates to the risk of developing a first episode of pericarditis after cardiac injury. In the current era of early reperfusion for acute MI, late pericarditis (Dresslers syndrome) is uncommon (0.5%) (11,12). […] Most cases of recurrent pericarditis with a typical clinical course of severe attacks, with strikingly elevated CRP followed by a prolonged period of quiescence with CRP normalization have probably an autoinflammatory pathogenesis, with unprovoked activation of inflammosome and production of IL1. We now know that colchicine may also inhibits the inflammosome, while anti-IL1 agents may specifically block IL1.

• #72 Understanding Dressler’s Syndrome: Causes, Symptoms & Treatment – The Kingsley Clinic

  https://thekingsleyclinic.com/resources/understanding-dresslers-syndrome-causes-symptoms-treatment/

  Dressler’s syndrome is a type of pericarditis, which refers to inflammation of the pericardium—the thin, sac-like membrane that encases the heart. This condition is believed to be an autoimmune response, where the immune system mistakenly attacks the body’s own tissues following damage to the heart. It typically develops weeks to months after events such as a heart attack, cardiac surgery, or chest trauma. […] Research suggests it occurs in approximately 1-5% of patients following a heart attack or cardiac surgery. […] Dressler’s syndrome is a serious condition that requires prompt recognition. Identifying symptoms early and seeking timely medical care can significantly improve outcomes and help prevent complications.

• #73 Dressler’s syndrome demonstrated by late gadolinium enhancement cardiovascular magnetic resonance | Journal of Cardiovascular Magnetic Resonance | Full Text

  https://jcmr-online.biomedcentral.com/articles/10.1186/1532-429X-11-23

  A 49-year old patient presented late with an anterolateral ST-elevation myocardial infarction and was treated with rescue angioplasty to an occluded left anterior descending artery. […] In contrast Dressler’s syndrome presents with a low-grade fever and chest pain 2 to 10 weeks after myocardial infarction, and is less common, affecting between 1 and 5% of patients. […] several possible pathogenic mechanisms have been proposed since including; autosensitisation to myocardial antigens released into the circulation during infarction, latent viruses or simply that the syndrome represents a prolonged and exaggerated form of early post-infarction pericarditis. […] It is postulated that the diminution of the infarct size and the shortened time of exposure of myocardial antigens to the immune system may be responsible. […] This case demonstrates that global pericardial inflammation in Dressler’s syndrome can be clearly visualised by LGE on CMR.

• #74 Dressler’s Syndrome | Doctor

  https://patient.info/doctor/dresslers-syndrome

  This is a late-onset post-myocardial infarction pericarditis, usually occurring one to six weeks after the initial event, although it can be delayed for as long as three months. […] It is thought to be immune-mediated (anti-myocardial antibodies may be present, although it is not known whether these are the cause of the syndrome or occur as a result of it.1 ). […] It is one of a heterogeneous group of conditions collectively known as post-cardiac injury syndrome (PCIS), which together represent a leading cause of pericarditis.2 PCIS includes Dressler’s syndrome (late-onset pericarditis following myocardial infarction (MI)), early-onset pericarditis following MI, post-cardiotomy syndrome and post-traumatic pericarditis. […] The reduction may be due to the fact that active intervention reduces the size of the infarct and therefore the area of damaged myocardium.

• #75 Dressler’s Syndrome | Doctor

  https://patient.info/doctor/dresslers-syndrome

  This is a late-onset post-myocardial infarction pericarditis, usually occurring one to six weeks after the initial event, although it can be delayed for as long as three months. […] It is thought to be immune-mediated (anti-myocardial antibodies may be present, although it is not known whether these are the cause of the syndrome or occur as a result of it.1 ). […] It is one of a heterogeneous group of conditions collectively known as post-cardiac injury syndrome (PCIS), which together represent a leading cause of pericarditis.2 PCIS includes Dressler’s syndrome (late-onset pericarditis following myocardial infarction (MI)), early-onset pericarditis following MI, post-cardiotomy syndrome and post-traumatic pericarditis. […] The reduction may be due to the fact that active intervention reduces the size of the infarct and therefore the area of damaged myocardium.

• #76 Post-myocardial infarction (Dressler’s) syndrome following early reperfusion – The British Journal of Cardiology

  https://bjcardio.co.uk/2012/05/post-myocardial-infarction-dresslers-syndrome-following-early-reperfusion/

  We present a case of a 55-year-old female with a successfully reperfused myocardial infarction in whom Dresslers syndrome was subsequently diagnosed. […] In conclusion, this case demonstrates that this syndrome is still a possibility in the current realm of thrombolysis and cardiac catheterisation. […] Dresslers, or post-cardiac injury, syndrome is a well-recognised complication of myocardial infarction; however, following the introduction of thrombolysis and cardiac catheterisation its continued existence in the era of reperfusion has been questioned. […] This demonstrates that despite the advances in medical care Dresslers syndrome continues to exist and should be considered in the differential of anyone presenting with chest pain in the setting of a recent myocardial infarction. […] While the exact mechanism has yet to be elucidated, it has been postulated to be an immune mechanism given the presence of the latency period, its correlation to actin and myosin antibody titres and its excellent response to anti-inflammatory agents. […] Essentially, this case serves as a reminder that Dresslers syndrome is a potential complication following a myocardial infarction, even in the era of reperfusion and with recent advances in medical care. […] To date, there has been no reported case of Dresslers syndrome following documented early reperfusion of a myocardial infarction. […] The presented case demonstrates that early reperfusion does not prevent this syndrome from occurring.

• #77 Post-myocardial infarction (Dressler’s) syndrome following early reperfusion – The British Journal of Cardiology

  https://bjcardio.co.uk/2012/05/post-myocardial-infarction-dresslers-syndrome-following-early-reperfusion/

  We present a case of a 55-year-old female with a successfully reperfused myocardial infarction in whom Dresslers syndrome was subsequently diagnosed. […] In conclusion, this case demonstrates that this syndrome is still a possibility in the current realm of thrombolysis and cardiac catheterisation. […] Dresslers, or post-cardiac injury, syndrome is a well-recognised complication of myocardial infarction; however, following the introduction of thrombolysis and cardiac catheterisation its continued existence in the era of reperfusion has been questioned. […] This demonstrates that despite the advances in medical care Dresslers syndrome continues to exist and should be considered in the differential of anyone presenting with chest pain in the setting of a recent myocardial infarction. […] While the exact mechanism has yet to be elucidated, it has been postulated to be an immune mechanism given the presence of the latency period, its correlation to actin and myosin antibody titres and its excellent response to anti-inflammatory agents. […] Essentially, this case serves as a reminder that Dresslers syndrome is a potential complication following a myocardial infarction, even in the era of reperfusion and with recent advances in medical care. […] To date, there has been no reported case of Dresslers syndrome following documented early reperfusion of a myocardial infarction. […] The presented case demonstrates that early reperfusion does not prevent this syndrome from occurring.

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