Dressler's Syndrome

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Question: Dressler's Syndrome

About 2 months after my heart bypass surgery, I began having constant pain over my heart. My doctor examined me and did some blood tests, and then told me I have something called Dressler's syndrome, which he says is an inflammation around my heart. He put me on medicine, which seemed to help a lot. He said this was a side effect from the surgery, and didn't seem too concerned about it. What is Dressler's syndrome and how worried should I be? And this something that could have been prevented?


Dressler's syndrome is the old name for what is now formally called “post-cardiac injury syndrome.” Most doctors still use the old name, because it is easier to say.

Dressler’s syndrome is a type of pericarditis (inflammation of the pericardial sac) that can follow any injury to the heart muscle - most commonly a myocardial infarction (heart attack), cardiac surgery, or blunt trauma to the chest. While Dressler's syndrome can occasionally lead to serious complications, it is usually a self-limited condition, and most often it can be treated fairly easily and very effectively.

What Causes Dressler’s Syndrome?

Dressler's syndrome can occur any time cardiac cells are damaged. The damage allows cardiac proteins to leak out of the cells, and these proteins can form "immune complexes" - clusters of molecules that can stimulate an inflammatory response. These immune complexes can accumulate in the pericardial sac, and sometimes in the lining of the lungs.

The body's immune system eventually begins attacking these immune complexes, causing inflammation in the pericardial sac, which produces pericarditis, and sometimes also pleuritis (inflammation of the lining of the lungs).

This immune reaction typically takes some time to develop, so Dressler's syndrome does not occur immediately following the cardiac injury itself.Rather, it occurs weeks or months afterwards.

Dressler's syndrome is not rare. It can be seen in 15% to 20% of people who have heart surgery.

How Is Dressler’s Syndrome Diagnosed?

In general it is not too difficult to diagnose Dressler's syndrome. The diagnosis is usually straightforward if there is a history of recent cardiac damage, followed by symptoms of pericarditis (especially chest pain that varies with breathing), fever, an elevated white blood cell count, and the appearance of characteristic changes on the electrocardiogram. Fluid accumulation around the heart or lungs can often be seen on a chest x-ray or an echocardiogram.

Treating Dressler’s Syndrome

Fortunately, treatment is also usually pretty straightforward. The inflammation produced by the immune reaction generally responds nicely to treatment with either aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. For people with known coronary artery disease NSAIDs should generally be avoided, and treatment with high-dose aspirin is usually preferred.

Dressler's syndrome also may respond to treatment with colchicine, a drug commonly used to treat acute gout. If these measures fail, a short course of treatment with steroids, such as prednisone, is virtually always effective.

So, as long as Dressler's syndrome is recognized and treatment is begun, it is usually not a serious medical condition.

This is likely why your doctor is not expressing much concern.

Preventing Dressler’s Syndrome

Regarding your second question, there is evidence that giving colchicine after cardiac surgery can reduce the risk of developing Dressler's syndrome by almost 60%. However, colchicine can cause significant gastrointestinal side effects that can complicate surgical recovery, and can interfere with other medications. Even with this prophylactic treatment, between 5 - 10% of patients having heart surgery still would be expected to develop Dressler's syndrome. So many cardiac surgeons believe the potential benefits of prophylactic colchicine are outweighed by the risks.


Wessman DE, Stafford CM. The postcardiac injury syndrome: case report and review of the literature. South Med J 2006; 99:309.

Imazio M, Brucato A, Markel G, et al. Meta-analysis of randomized trials focusing on prevention of the postpericardiotomy syndrome. Am J Cardiol 2011; 108:575.

Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol 2013; 168:648.

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