Dressler's Syndrome Heart Muscle Injury

Post-Cardiac Injury Syndrome

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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, or inflammation of the pericardial sac. The pericardial sac is a sac-like layer of tissue that surrounds the heart, which contains a small amount of fluid that provides lubrication for the movement of the heart.

When a person develops pericarditis, their pericardial sac becomes inflamed, and excess fluid usually accumulates within it (a condition called a pericardial effusion). Dressler’s syndrome is generally like any other kind of pericarditis. The reason it gets a special name is because of its stereotypical pattern of occurrence — namely, it occurs several weeks after some type of injury to the heart muscle.

Most often, Dressler’s syndrome occurs after a heart attackcardiac 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 muscle 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 as well. The body's immune system eventually may begin 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 afterward.

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. Effusions (fluid accumulations) around the heart or lungs can often be seen on a chest x-ray or an echocardiogram.

Treating Dressler’s Syndrome

Fortunately, the treatment of Dressler’s syndrome usually is also pretty straightforward. The inflammation that causes this condition generally responds nicely to treatment with either aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. For people with coronary artery disease, NSAIDs should generally be avoided (read why), and treatment with high-dose aspirin is usually preferred instead.

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 rarely develops into a serious medical condition.

This is likely why your doctor is not expressing very 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, especially since most times Dressler’s syndrome responds readily to treatment, many cardiac surgeons believe the potential benefits of prophylactic colchicine are outweighed by the risks.

Sources:

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.

Wessman DE, Stafford CM. The Postcardiac Injury Syndrome: Case Report and Review of the Literature. South Med J 2006; 99:309.

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