History

The most constant symptom of dressler syndrome is pleuritic chest pain, typically located retrosternally or on the left precordial region and which is charasteristically relieved by leaning forward and worsened by lying flat [10] [11]. Another common feature of dressler syndrome is fever, which is often low grade [11]. Pneumonitis also occurs sequel to pericardial inflammation.

A history of myocardial infarction, pericardial surgery or injury is required to make a diagnosis of dressler syndrome. A history of risk factors of myocardial infarction should also be sought, these risk factors include obesity, hypertension, family history of ischaemic heart diseases, smoking, and dyslipedemia [10] [11].

Physical examination

Characteristically, on physical examination in dressler syndrome, a pericardial rub is heard on auscultation. This sound results from friction between the inflamed visceral and parietal pericardial layers. The sound is best heard near the end of expiration over the left lower sternal border with the patient leaning forward. Pleural effusion is also a typical finding in dressler syndrome. Another typical finding on physical examination is a dull percussion note in the left upper lung zone and scapular area, this is due to the collapse of the left lung sequel to compression by the enlarged pericardium which results from massive effusion into the pericardial space. This is called Ewart's sign. It is also common to find tachycardia and tachypnea in dressler syndrome.

• Fever

  Dressler syndrome is more paucisymptomatic with few manifestations, such as fever, malaise, and chest pain [ 15, 16 ]. [ncbi.nlm.nih.gov]

  Dressler syndrome presents with low grade fever, pleuritic chest pain, and pericardial friction rub. [symptoma.com]

  Other clinical features can include fever, an elevated white blood cell count and pericardial effusion (a build-up of fluid in the pericardium). [clinicianrevision.com]

  Little is known about the incidence of fever in the days following pulmonary embolism and such fever could depend on comorbidities. [em-consulte.com]

  It is characterized by chest pain, fever, pericarditis with a friction rub, pleurisy, pleural effusion, joint pain, and elevated white blood cell count and sedimentation rate. [medical-dictionary.thefreedictionary.com]

• Malaise

  Dendale, M.D., Ph.D. 1 Citing Article A 57-year-old woman was referred to our clinic because of malaise, dyspnea, and pedal edema four weeks after an extensive myocardial infarction. [nejm.org]

  Facts : Post myocardial infarction pericarditis Usually occurs weeks after a myocardial infarction History / PE : Malaise, fever Pain worse with deep inspiration, improved by leaning forward Diagnosis : Elevated ESR Diffuse ST segment elevation Treatment [medlibes.com]

  pericarditis after heart attack or open-heart surgery that is often recurrent and is typically accompanied by chest pain, fever, malaise, difficulty in breathing, pleurisy, and pericardial and pleural effusions Dictionary Entries Near Dressler's syndrome [merriam-webster.com]

• Congestive Heart Failure

  There are no other signs of congestive heart failure. [learningradiology.com]

  Only one of these cases showed gross signs of congestive heart failure. [litfl.com]

  These include: pneumonia pulmonary embolism angina congestive heart failure heart attack A doctor may suspect you have Dressler syndrome if you start feeling ill a few weeks after heart surgery or a heart attack. [healthline.com]

  Association, American Society of Nephrology, and Central Society for Clinical Research Disclosure: Genzyme Honoraria Speaking and teaching G Shawn Lynchard, MD Consulting Cardiologist, Medical Director of Cardiac Care Unit, Congestive Heart Failure Clinic [medscape.com]

  Possible Complications Possible complications of pericarditis are: Cardiac tamponade Congestive heart failure Constrictive pericarditis When to Contact a Medical Professional Call your provider if: You develop symptoms of pericarditis after a heart attack [pennmedicine.org]

• Swelling

  Due to this, it is also referred to as Post-Myocardial Infarction Syndrome Pericarditis refers to swelling and inflammation of the pericardium, a sac-like layer that covers the heart. [dovemed.com]

  When the body tries to clean and repair the diseased heart tissue, swelling and inflammation occur. Late pericarditis (Dressler syndrome). [humanitas.net]

  Pericarditis is inflammation and swelling of the covering of the heart (pericardium). It can occur in the days or weeks following a heart attack. Two types of pericarditis can occur after a heart attack. [medlineplus.gov]

  Signs and symptoms: Main signs and symptoms Dressler syndrome include persistent low-grade fever, chest pain (pleuritic in nature), pericarditis (swelling and irritation of the thin, sac-like membrane surrounding the heart, usually evidenced by a pericardial [xpertdox.com]

• Sepsis

  This list would include the following: Pulmonary embolus Sepsis Pneumonia Congestive heart failure Influenza Recurrent cardiac injury (such as acute MI/in-stent re-stenosis or valve failure) Acute anemia with or without GI bleed Endocarditis Uremia Secondary [ncbi.nlm.nih.gov]

  […] disorder Secondary hypertension Sheehan's syndrome, Schizoid personality disorder Self-injury/cutting Shellfish allergy, Schizophrenia Separated shoulder Shigella infection, Schizotypal personality disorder Separation anxiety Shin splints, Sciatica Sepsis [sites.google.com]

• Pleural Effusion

  […] silhouette enlargement from pericardial effusion and mild to moderate-sized left (usually) pleural effusion Pleural effusion may be bilateral Pleural effusions (83%) Parenchymal opacities (74%) Enlarged cardiac silhouette from pericardial effusion (49% [learningradiology.com]

  Roentgenologic evidence of pericardial effusion was found in two cases. Pleural effusion occurred in seven. [litfl.com]

  Transthoracic echocardiography showed a mean pericardial circumferential effusion of 8±2 mm, and chest X-ray was suggestive of bilateral mild pleural effusion in all. Corticosteroids were prescribed in 3 and NSAIDs plus colchicine in 2 patients. [ahajournals.org]

  Chest radiography showed a cardiac area in the upper normal limit, and mild right pleural effusion. [ircmj.com]

  To the Editor: Pericardial disease is a relatively infrequent cause of pleural effusions requiring diagnostic thoracenteses. It accounted for only 4% of 3,077 analyzed pleural effusions in a large Spanish series (1). [atsjournals.org]

• Pleuritic Pain

  Hospital re-admission was required in all after an average of 13.2±5.2 days, due to worsening dyspnea, pleuritic pain, and low-grade fever. [ahajournals.org]

  Differential diagnosis Dressler syndrome needs to be differentiated from pulmonary embolism, another identifiable cause of pleuritic (and non-pleuritic) chest pain in people who have been hospitalized and/or undergone surgical procedures within the preceding [research.omicsgroup.org]

  The symptoms mainly consist of fever, pleuritic pain, pericarditis and pericardial effusion. [xpertdox.com]

  pleuritic pain vomiting (in children prior to tamponade) can progress to tamponade -> cardiovascular collapse RISK FACTORS recent pericardotomy post MI (Dresslers syndrome) coronary stent epicardial pacemaker leads tranvenous pacemaker leds blunt trauma [lifeinthefastlane.com]

  Differential diagnosis The pain may initially suggest a further episode of angina or MI. Pleuritic chest pain may also suggest pneumonia or pulmonary embolism. [patient.info]

• Tachypnea

  It is also common to find tachycardia and tachypnea in dressler syndrome. Work up approach considrations in dressler syndrome includes initial baseline laboratory investigations, cardiac imaging, and pericardiocentesis. [symptoma.com]

  […] of a monophasic rub occurring with the respiratory cycle in the absence of diagnostic changes on ECG or elevated cardiac enzymes should alert physicians to the possibility of pleuritis. 3 Physical findings that suggest acute cardiac tamponade include tachypnea [aafp.org]

  Tachycardia and tachypnea are common. Pulsus paradoxus is defined as an inspiratory decline in systolic blood pressure of more than 10 mmHg resulting from compression and poor filling of the left ventricle. [clevelandclinicmeded.com]

• Common Cold

  Churg-Strauss syndrome Colon cancer, Chondromalacia patella Cirrhosis Colon polyps, Chronic cough Claudication Coma, Chronic daily headaches Cleft lip and cleft palate Common cold in babies, Chronic exertional compartment syndrome Clubfoot Common warts [sites.google.com]

• Chest Pain

  Although rare, it is a syndrome that must be considered in the differential diagnosis of chest pain. Keywords Chest Pain Myocardial Infarction Pericarditis Dressler Syndrome Copyright © 2015, Iranian Red Crescent Medical Journal. [ircmj.com]

  Dressler syndrome is more paucisymptomatic with few manifestations, such as fever, malaise, and chest pain [ 15, 16 ]. [ncbi.nlm.nih.gov]

  Clinical features The most common symptom of Dressler’s Syndrome is chest pain, which is usually located in the middle or left side of the chest. The pain is often described as a dull, aching pain, and it may be worse when the person is lying down. [clinicianrevision.com]

  Symptoms might include: Chest pain Fever When to see a doctor Seek emergency care for persistent chest pain, which may indicate a recurring heart attack or other disorder. [drugs.com]

• Pericardial Friction Rub

  A pericardial friction rub was heard in eight cases. Roentgenologic evidence of pericardial effusion was found in two cases. Pleural effusion occurred in seven. [litfl.com]

  Physical examination revealed jugular venous distention and pulsus paradoxus but no pericardial friction rub. Cine magnetic resonance imaging showed massive pericardial effusion (arrows) and a swinging motion of the heart ( video clip ). [nejm.org]

  Signs and Symptoms Pleuritic chest pain Fever Malaise Pericardial friction rub Findings EKG findings characteristic of pericarditis Pericardial effusion Pleural effusion Leukocytosis, elevated ESR or CRP[2] Differential Diagnosis CHF PE Pneumonia Pneumothorax [wikem.org]

• Heart Disease

  diseases I24.0 Acute coronary thrombosis not resulting in myocardial infarction I24.1 Dressler's syndrome I24.8 Other forms of acute ischemic heart disease I24.9 Acute ischemic heart disease, unspecified I25 Chronic ischemic heart disease I25.1 Atherosclerotic [icd10data.com]

  Helsinki Heart Study: Primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia: safety of treatment, changes in risk factors, and incidence of coronary heart disease. ‎ [books.google.es]

  NSAIDs though once used to treat Dressler syndrome, are less advocated and should be avoided in patients with ischemic heart disease. [dictionnaire.sensagent.leparisien.fr]

  For antibody to cardiac muscle v • d • e Circulatory system pathology (I, 390-459) Hypertension Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension) Ischaemic heart disease Angina pectoris (Prinzmetal's [bionity.com]

• Heart Failure

  There are no other signs of congestive heart failure. [learningradiology.com]

  Only one of these cases showed gross signs of congestive heart failure. [litfl.com]

  Chest radiography revealed cardiomegaly and increased vascular markings consistent with decompensated heart failure (Figure 2). [acc.org]

  failure (Diastolic heart failure, Cardiac asthma) · Rheumatic fever M: HRT anat/phys/devp noco/cong/tumr, sysi/epon, injr proc, drug (C1A/1B/1C/1D), blte [dictionnaire.sensagent.leparisien.fr]

  Association, American Society of Echocardiography, Heart Failure Society of America, South Carolina Medical Association Disclosure: Nothing to disclose. [medscape.com]

• Tachycardia

  We encountered an unusual association of large pericardial effusion secondary to Dressler's syndrome and intractable ventricular tachycardia that reverted upon pericardiocentesis. [jiaecho.org]

  Search dictionary help Dressler beat medical dictionary Fusion beat interrupting a ventricular tachycardia and producing a normally narrow QRS complex as a result of the fusion of two impulses, one impulse from the ventricular tachycardia and the other [mondofacto.com]

  Dressler beat - presence of Dressler beats strongly supporting the diagnosis of ventricular tachycardia by interruption of it. Dressler syndrome - Synonym(s): pericarditis [medical-dictionary.thefreedictionary.com]

  […] arrhythmia Bradycardia Sinus bradycardia · Sick sinus syndrome Heart block: Sinoatrial · AV (1°, 2°, 3°) · Intraventricular (Bundle branch/Right/Left, Left anterior fascicular/Left posterior fascicular, Bifascicular/Trifascicular) · Adams–Stokes syndrome Tachycardia [dictionnaire.sensagent.leparisien.fr]

  Polymorphic ventricular tachycardia Sustained (≥ 30 seconds) monomorphic ventricular tachycardia Any ventricular tachycardia with symptoms of instability (eg, heart failure, hypotension, chest pain) Ventricular tachycardia without hemodynamic instability [msdmanuals.com]

• Irritability

  Signs and symptoms: Main signs and symptoms Dressler syndrome include persistent low-grade fever, chest pain (pleuritic in nature), pericarditis (swelling and irritation of the thin, sac-like membrane surrounding the heart, usually evidenced by a pericardial [xpertdox.com]

  Moderate cases of Dressler’s syndrome may necessitate the administration of anti-inflammatory medications to ease pericardial irritation. Additional medications may also be given to suppress the body’s immuno-response to existing inflammation. [wisegeek.com]

  Dressler's syndrome causes twisting, burning, irritant pain that may come and go. Dressler's syndrome can also cause fever, pain that gets worse with heavy breathing, and a "squeaky heart" due to a pericardial friction rub. [steadyhealth.com]

  Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

Work up approach considrations in dressler syndrome includes initial baseline laboratory investigations, cardiac imaging, and pericardiocentesis.

Complete blood count reveals leukocytosis with left shift. However, blood cultures are typically negative to rule out a bacterial cause of acute pericarditis. Blood cultures are, therefore, very necessary as part of the initial laboratory studies. Serology reveals a high titer of antimyocardial antibodies. Typically, erythrocyte sedimentation rate (ESR) and C-reactive protein level are evelated. Cardiac enzyme levels are not necessary in the diagnosis of dressler syndrome as results remain unchanged as in patients without dressler syndrome who have had pericardial injury or myocardial infarction. As part of baseline investigations, pericardial fluid should be sent for microscopic analysis, biochemistry, and cultures.

Cardiac imaging includes electrocardiography (ECG), chest radiography, echocardiography, and cardiac magnetic imaging resonance (MRI) which are all indicated in dressler syndrome. However, echocardiography is the diagnostic modality of choice in dressler syndrome.

Chest radiographs typically show effacement of the costophrenic angles from pleural effusion, and an enlarged cardiac silhouette due to pericardial effusion. 

Findings on the ECG include T-wave inversion, low QRS amplitude, and ST segment elevation. A low QRS amplitude is most commonly seen if the pericardial effusion is massive. 

The echocardiography is more sensitive than chest radiography [12]. Echocardiography helps exclude other differentials such as congestive heart failure with the characteristic finding of fluid collection posterior to the left ventricle during systole. Cardiac MRI is indicated to clearly reveal pericardial fluid collection which has not been clearly delineated with echocardiography.

Pericardiocentesis is both a diagnostic and therapeutic procedure. Pericardial inflammation causes effusion and collection of fluid in the pericardial potential space, overtime, the fluid accumulated makes the pericardium massively enlarged compressing the heart, thereby restricting outflow and cardiac output. This is called cardiac tamponade and it requires urgent management. Echocardiography-guided pericardiocentesis is the recommended initial management method for significant pericardial effusion and cardiac tamponade. The drainage is usually done over 24-48 hours.

• Pericardial Effusion

  We coined a term “electrical tamponade” to describe an electrical storm or high-grade ventricular arrhythmias secondary to pericardial effusion. [FULL TEXT] [PDF]* [jiaecho.org]

  Parasternal long axis echocardiographic image demonstrating the pericardial effusion (arrow). Figure 1.  Parasternal long axis echocardiographic image demonstrating the pericardial effusion (arrow). [tandfonline.com]

  We excluded patients with pericardial tamponade due to a small amount of effusion or to localized pericardial effusion. [ncbi.nlm.nih.gov]

  The pericardial effusion cleared with short-term therapy with corticosteroids and the prolonged use of indomethacin. [unboundmedicine.com]

  Patient developed rapid atrial fibrillation and mild pericardial effusion on day 1 and was started on prednisone and a dilatiazem drip for treatment. [shmabstracts.org]

• Neutrophilia

  At re-admission, all 5 patients had moderate-severe leucocytosis with neutrophilia, as well as bilateral rales and pericardial friction rub. [ahajournals.org]

  Inflammatory markers were markedly elevated, with a C-reactive protein level of 290 mg/L (RR, 9 /L (RR, 4–11 × 10 9 /L), with predominant neutrophilia, and her platelet count was significantly elevated at 800 × 10 9 /L (RR, 150–400 × 10 9 /L). [mja.com.au]

• ST Elevation

  Inset shows ST elevation and Q waves in V3. B. Coronary angiography after successful PCI to the LAD. Inset shows partial resolution of ST elevation and persistent Q waves. C. [internationaljournalofcardiology.com]

  Pericarditis can cause localised ST elevation but there should be no reciprocal ST depression (except in AVR and V1). STEMI, like pericarditis, can also cause concave up ST elevation. Only STEMI causes convex up or horizontal ST elevation. [lifeinthefastlane.com]

  ESR or CRP[2] Differential Diagnosis CHF PE Pneumonia Pneumothorax Aortic dissection Pneumomediastinum Pleuritis ST Elevation Cardiac ST-segment elevation myocardial infarction (STEMI) Post-MI (ventricular aneurysm pattern) Previous MI with recurrent [wikem.org]

  The ECG showed anterolateral ST elevation and because of this and ongoing pain, she was thrombolysed with retaplase despite the late presentation. [jcmr-online.biomedcentral.com]

  At presentation, an electrocardiogram demonstrated 1–2 mm ST elevation in leads V1–V6, I and aVL ( Box 1 ). [mja.com.au]

• Pleural Effusion

  […] silhouette enlargement from pericardial effusion and mild to moderate-sized left (usually) pleural effusion Pleural effusion may be bilateral Pleural effusions (83%) Parenchymal opacities (74%) Enlarged cardiac silhouette from pericardial effusion (49% [learningradiology.com]

  Roentgenologic evidence of pericardial effusion was found in two cases. Pleural effusion occurred in seven. [litfl.com]

  Transthoracic echocardiography showed a mean pericardial circumferential effusion of 8±2 mm, and chest X-ray was suggestive of bilateral mild pleural effusion in all. Corticosteroids were prescribed in 3 and NSAIDs plus colchicine in 2 patients. [ahajournals.org]

  Chest radiography showed a cardiac area in the upper normal limit, and mild right pleural effusion. [ircmj.com]

  To the Editor: Pericardial disease is a relatively infrequent cause of pleural effusions requiring diagnostic thoracenteses. It accounted for only 4% of 3,077 analyzed pleural effusions in a large Spanish series (1). [atsjournals.org]

• Pleural Rub

  This can be distinguished from pericardial rubs by asking the patient to halt respirations. The pleural rub will be absent with suspension of respirations while pericardial rubs will still be present. E. What diagnostic tests should be performed? 1. [clinicaladvisor.com]

Initial evaluation and treatment of dresser syndrome in a hemodynamically stable patient is usually on an outpatient basis. Initial care is largely conservative with nonsteroidal anti-inflammatory drugs prescribed for up to 6 weeks, doses of which are tapered as the collected fluid reduces. Corticosteroids are indicated if treatment with NSAIDs fail to resolve the inflammatory process. Certain reports have revealed successful treatment of recurrent cases of dressler syndrome with a single high dose of intravenous immunoglobulin in a patient and a weekly administration of low dose methotrexate in another patient [13].

More severe cases, especially involving cardiac tamponade are managed as emergencies in an inpatient setting. Cardiac tamponade is treated with urgent pericardiocentesis, after which patients may be continued on outpatient care, if they show satisfactory improvement.

Surgery is indicated in cases of relapse or persistence of symptoms despite medical treatment. Surgical procedures indicated in these cases include open thoracotomy or video-assisted thoracoscopy and percutaneous gallon pericardiotomy [14]. These procedures basically serve the same purpose: creation of a pericardial window through which pericardial fluid drains. However, percutaneous balloon pericardiotomy is less invasive and involves flouroscopic-guided balloon catheterization [15]. In this procedure, the pericardial fluid is shunted through a surgical defect in the diaphragm into the abdominal cavity.

Generally, the prognosis of dressler syndrome is benign, with the outcome largely determined by the severity of the underlying cardiac disease. Most cases of dressler syndrome resolve within a few weeks, however, in a few cases, the symptoms may persist for a number of months. Relapses occur in up to 15% of patients [9]. Most relapses occur within 6 months of the inciting surgery or injury.

Complications of dressler syndrome include cardiac tamponade, constrictive pericarditis, hypoxaemia, and occlusion of a coronary bypass graft. Constrictive pericarditis is however, neither exclusively nor frequently caused by dressler syndrome.

Cardiac tamponade is the restriction of ventricular filling and outflow sequel to massive effusion and thickening of the pericardium. Cardiac tamponade, being a life-threatening condition, requires urgent pericardiocentesis. Cardiac tamponade occurs in about 1% of cases of dressler syndrome. In addition, occlusion of a coronary bypass graft is a rare complication of dressler syndrome.

Dressler syndrome has an unknown etiology, however autoimmunity has been associated with its pathogenesis [5]. This is suggested by serologic findings of antimyocardial antibodies. However, the presence of these antibodies are yet to be linked to either the cause or the result of this syndrome. Reports of pericardial surgeries showed that a high titer of the anti myocardial antibodies was associated with the development of dressler syndrome.

Dressler syndrome was first described by Dressler in 1956 in which he noted that the syndrome had an incidence rate of 3-4% of all cases of acute myocardial infarction [6]. However, the incidence rate is now much reduced because of better treatment methods for acute myocardial infarction. Dressler syndrome is rarely seen in children under 2 years.

The etiology and pathogenesis of dressler syndrome is not clearly understood, however, studies show that it most likely has an autoimmune basis [7]. Other hypotheses include viral infections and localized inflammatory processes. In over 60% of cases, viruses including cytomegalovirus, coxackie B and adenovirus, have been shown to be present in patients with this syndrome, thus suggesting that the syndrome may be an antibody response to a viral infection. Nonetheless, a study showed no presence of viruses in patients with the syndrome postpericardiotomy [8]. Dressler syndrome is most commonly associated with intramural myocardial infarction.

The incidence of Dressler's syndrome is much reduced by use of NSAIDs post-pericardial or cardiac surgery. However, prophylactic steroid use prior to cardiac surgery doesn't prevent this syndrome [16].

Dressler syndrome is an inflammatory reaction involving the pericardium, often occurring secondary to pericardial surgeries, injuries, and myocardial infarction, hence, Dressler syndrome is also referred to as post-myocardial infarction syndrome and postpericardiotomy syndrome [1]. Other common triggers of dressler syndrome include heart puncture, blunt trauma, pacemaker implantation, and coronary stenting [2].

The syndrome presents as an acute pericarditis with low grade fever, pleuritic chest pain, pericardial friction rubs and pericardial effusion which could progress into cardiac tamponade, a life-threatening condition [3] [4]. In a few recurrent cases of dressler syndrome, cardiac tamponade may also recur. Dressler syndrome, in few cases, may recur years after the inciting surgery and initial treatment.

Diagnosis of dressler syndrome is largely clinical, with characteristic findings on physical examination including pericardial friction rub, and a history of myocardial infarction, cardiac surgeries or injuries. Although, dressler syndrome is somewhat similar to peri-infarction pericarditis which follows a myocardial infarction, dressler syndrome often presents several weeks to months after an infarction as opposed to the early onset of peri-infarction pericarditis.

Common surgical procedures associated with the development of dressler syndrome include surgical corrections of atrial septal defects, ventricular septal defects and fallot's tetralogy, and cardiac transplantation.

The pathophysiology of dressler syndrome is not clearly understood, however, it is theorized to be a result of an autoimmune process, as evidenced by the presence of antimyocardial antibodies, and its sensitivity to anti-inflammatory drugs.

Clinical evaluation is always supported by laboratory investigation to confirm a diagnosis of dressler syndrome. Cardiac imaging provides characteristic features for the diagnosis and could be employed therapeutically to treat this syndrome. Treatment involves drainage of the peicardial fluid and administration of anti-inflammatory drugs. Cardiac tamponade is, however, treated as an emergency with an urgent drainage of the collected pericardial fluid.

Dressler syndrome is an inflammatory condition of the covering of the heart, the pericardium, after a heart attack, or after an injury or surgical procedure involving the heart or the pericardium. It is a condition characterised by chest pain, and fever. This pericardium is made up of two layers.

Causes

Doctors are not so clear about how the disease results, although they have postulated a theory, based on findings in a lot of cases, that the disease may result from the body's antibodies attacking the heart and pericardium. The antibodies were originally meant to repair the damaged heart tissue, but end up damaging it by causing excessive inflammation.

Symptoms

Dressler syndrome typically presents with pain in the middle of the chest which gets worse with lying flat and is  relieved by leaning forward. The pain is usually described as an intermittent squeezing, burning sensation as opposed to a heart attack in which the pain is continuous. Another common symptom of this disease is a mild fever.

Prognosis

The inflammation of the pericarditis leads to release of fluids from the blood vessels around the pericardium. This fluid collects gradually, and if the condition is untreated, may collect till it becomes massive compressing the heart and restricting the heart's ability to pump out blood. This phenomenon is called cardiac tamponade and is a medical emergency.

Diagnosis

Doctors can make a diagnosis of dressler syndrome from the history and examination findings. A history of the typical chest pain and fever which occur after heart surgery or a heart attack suggests dressler syndrome. Your doctor would listen for a typical sound called pericardial rub, on placing the stethoscope on your chest. This sound is due to the irritation of the two layers of the pericardium when you breathe.

To confirm this diagnosis, however, your doctor may require radiological films including Chest X-ray, CT scan, echocardiography, and magnetic resonance imaging (MRI) of the heart. An electrocardiogram (ECG) may also be necessary. The echocardiograph is a technique which uses very high frequency sound waves to create an image of the heart to reveal the characteristic fluid collection in the pericardium and exclude other diseases which could cause similar symptoms. The ECG uses electrical wires plugged to the chest to check for the changes in the electrical activity of the heart.

Blood tests would also be ordered to reveal features characteristic of this condition.

Treatment

Treatment of this condition basically includes administration of over-the-counter pain medications such as advil and aspirin. Steroids are powerful immune suppressants which also serve to reduce the inflammation and pain in this condition. Doctors use steroids in testing dressler syndrome when over-the-counter pain medications do not resolve the symptoms.

The complications of this condition would also be treated. Cardiac tamponade is treated with urgent drainage of the fluid using a catheter. In severe and recurrent cases, surgery may be necessary to drain the fluid from the pericardium. Such surgical procedures create a hole in the pericardium through which the fluid drain to another safe site, usually in the abdomen.

1. Hutchcroft BJ. Dressler's syndrome. Br Med J. 1972 Jul 1; 3(5817):49.
2. Tabatznik B, Isaacs JP. Postpericardiotomy syndrome following traumatic hemopericardium. Am J Cardiol. 1961 Jan; 7:83-96.
3. Herrera-Franco R, Narvaez-Rivera JL, Benitez-Perez C, et al. Recurrent cardiac tamponade secondary to postpericardiotomy syndrome. Gac Med Mex. 1999 Nov-Dec; 135(6):593-7.
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9. Prince SE, Cunha BA. Postpericardiotomy syndrome. Heart Lung 1997; 26:165–8.
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12. Tingle L, Molina D, Calvert C. Acute pericarditis. Am Fam Physician. 2007 Nov 15; 76(10):1509-14.
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15. Forbes TJ, Horenstein MS, Vincent JA. Balloon pericardiotomy for recurrent pericardial effusions following fontan revision. Pediatr Cardiol. 2001 Nov-Dec; 22(6):527-9.
16. Wessman DE, Stafford CM. The postcardiac injury syndrome: case report and review of the literature. South Med J. 2006 Mar; 99(3):309-14.