Dressler's syndrome. post MI syndrome, postcardiac injury syndrome (PCIS)
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Etiology
- uncommon late complication of myocardial infarction (MI).
Epidemiology
- 3% of patients after MI
Pathology
- inflammatory response
- immune-complex deposition in the pericardium & lung pleura
Clinical manifestations
- onset of symptoms 2-10 weeks post MI
- pericarditis, pericardial rub, pericardial effusion
- pleuritis, pleural effusion
- chest pain
- generally arises from inflammation of parietal pleura
- generally sharp, pleuritic, worsened with inspiration
- positional, relieved by sitting up, leaning forward
- fever, malaise
- course of disease may be long
- frequent exacerbations & remissions
Laboratory
- complete blood count (CBC): leukocytosis
- elevated erythrocyte sedimentation rate (ESR)
- anti myocardial antibodies
- pleural fluid analysis
- may show RBC, lymphocytes, reactive mesothelial cells
- protein < that of serum
- normal glucose
- gram stain negative for bacteria
Diagnostic procedures
- electrocardiogram:
- diffuse ST segment elevation (may be marked) or diffuse PR-segment depression[3]
- echocardiogram: pericardial effusion
- thoracentesis
Radiology
Management
- symptomatic treatment
- colchicine + full dose aspirin
- avoid non-aspirin nonsteroidal antiinflammatory drugs & glucocorticoids because they impede myocardial healing[3]*
- prednisone or other glucocorticoid
- severe pain refractory to aspirin & colchicine or contraindications to aspirin & colchicine
- prednisone 1 mg/kg QD with taper
- discontinue anticoagulation if possible to avoid hemorrhagic pericarditis
* ref[3] describes case of Dressler's syndrome after MI with placement of drug-eluting stent. Clopidogrel is not mentioned in the case discussion, nor the risk of hemorrhage with full- dose aspirin + clopidogrel
More general terms
Additional terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 112
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015
- ↑ 3.0 3.1 3.2 3.3 NEJM Knowledge+ Question of the Week. Aug 23, 2016 http://knowledgeplus.nejm.org/question-of-week/32/