Dressler syndrome

Cardiovascular

Clinicals - History

Fact Explanation
Pleuritic chest pain This is characteristic. Patients complain of retrosternal or left precordial pain. Characteristically chest pain is relieved by leaning forwards and exacerbated by lying supine. Pleuritic chest pain
This is characteristic. Patients complain of retrosternal or left precordial pain. Characteristically chest pain is relieved by leaning forwards and exacerbated by lying supine.
Fever Low grade fever is commonly seen. This is due to inflammation of the pericardium. Fever
Low grade fever is commonly seen. This is due to inflammation of the pericardium.
History of myocardial infarction Dressler’s syndrome is a relatively rare complication of myocardial infarction which occurs within 2 to 10 weeks after a myocardial infarction. History of myocardial infarction
Dressler’s syndrome is a relatively rare complication of myocardial infarction which occurs within 2 to 10 weeks after a myocardial infarction.
Cardiovascular risk factors Obesity, hyperlipidemia, hypertension, smoking, positive family history of ischemic heart diseases are cardiovascular risk factors. Cardiovascular risk factors
Obesity, hyperlipidemia, hypertension, smoking, positive family history of ischemic heart diseases are cardiovascular risk factors.

Clinicals - Examination

Fact Explanation
Fever Low grade fever can be detected in some patients. Fever
Low grade fever can be detected in some patients.
Pericardial rub Pericardial rub is heard due to the pericardial inflammation and effusion. It is best heard over the left lower sternal edge in end expiration and the patient should be leaning forward. It occurs as the two pericardial layers rub against each other. Pericardial rub
Pericardial rub is heard due to the pericardial inflammation and effusion. It is best heard over the left lower sternal edge in end expiration and the patient should be leaning forward. It occurs as the two pericardial layers rub against each other.
Ewart's sign This sign is the presence of dullness to percussion in the scapular region. When the fluid filled pericardium bulges and compresses the left lung it collapses resulting dull percussion note. Ewart's sign
This sign is the presence of dullness to percussion in the scapular region. When the fluid filled pericardium bulges and compresses the left lung it collapses resulting dull percussion note.
Pulse Tachycardia is common. Pulsus paradoxus can occur in acute severe effusions. Pulse
Tachycardia is common. Pulsus paradoxus can occur in acute severe effusions.
Respiratory rate Tachypnea can be seen in acute pericarditis. Respiratory rate
Tachypnea can be seen in acute pericarditis.

Investigations - Diagnosis

Fact Explanation
Full blood count Leukocytosis and left shift is common. Full blood count
Leukocytosis and left shift is common.
Chest X-ray Although not specific chest X-ray can also detect pericardial effusions of more than 250ml. The cardiac silhouette is enlarged in these instances. Chest X-ray
Although not specific chest X-ray can also detect pericardial effusions of more than 250ml. The cardiac silhouette is enlarged in these instances.
Transthoracic echocardiogram Echocardiogram visualizes the pericardial effusion between the visceral and parietal pericardial sacs. This can also demonstrate the hemodynamics in cardiac tamponade. Transthoracic echocardiogram
Echocardiogram visualizes the pericardial effusion between the visceral and parietal pericardial sacs. This can also demonstrate the hemodynamics in cardiac tamponade.
ECG Shows pathological Q waves indicating a previous myocardial infarction. Gradual repolarization changes are indicative of pericarditis. During the early stages upwardly concave ST-segment elevation can be seen in all the leads. T-wave inversion and PR-segment depression can be seen in ECG. ECG
Shows pathological Q waves indicating a previous myocardial infarction. Gradual repolarization changes are indicative of pericarditis. During the early stages upwardly concave ST-segment elevation can be seen in all the leads. T-wave inversion and PR-segment depression can be seen in ECG.
Cardiac MRI scan (CMR) or CT scan These are valuable investigation modalities to diagnose pericardial pathologies. In Dressler's syndrome global pericardial inflammation can be detected. Cardiac MRI scan (CMR) or CT scan
These are valuable investigation modalities to diagnose pericardial pathologies. In Dressler's syndrome global pericardial inflammation can be detected.
Late gadolinium enhancement scan Shows pericardial inflammation and thickening. This test has high sensitivity and specificity in detecting pericardial inflammation. Late gadolinium enhancement scan
Shows pericardial inflammation and thickening. This test has high sensitivity and specificity in detecting pericardial inflammation.
C-reactive protein (CRP) CRP is elevated as a result of pericardial inflammation. C-reactive protein (CRP)
CRP is elevated as a result of pericardial inflammation.
Erythrocyte sedimentation rate (ESR) ESR is raised in some patients due to pericardial inflammation. Erythrocyte sedimentation rate (ESR)
ESR is raised in some patients due to pericardial inflammation.
Antimyocardial antibodies Positive antimyocardial antibodies suggest the diagnosis. Antimyocardial antibodies
Positive antimyocardial antibodies suggest the diagnosis.

Investigations - Management

Fact Explanation
Transthoracic echocardiogram Constrictive pericarditis is a rare but significant complication of recurrent pericardial effusions. Transthoracic echocardiogram
Constrictive pericarditis is a rare but significant complication of recurrent pericardial effusions.

Management - Specific

Fact Explanation
Non-steroidal anti-inflammatory drugs Although many patients recover even without treatment, non-steroidal anti-inflammatory drugs are used in treatment. Ibuprofen is preferred because it suppresses the pericardial inflammation and simultaneously improves the coronary perfusion. Non-steroidal anti-inflammatory drugs
Although many patients recover even without treatment, non-steroidal anti-inflammatory drugs are used in treatment. Ibuprofen is preferred because it suppresses the pericardial inflammation and simultaneously improves the coronary perfusion.
Corticosteroids Steroids also suppress the inflammation, but it should be used with caution as it prolongs the cardiac remodeling as well. Corticosteroids
Steroids also suppress the inflammation, but it should be used with caution as it prolongs the cardiac remodeling as well.
Pericardiocenthesis This is useful if the pericardial effusion is large and if it causes significant tamponade effects. Pericardiocenthesis
This is useful if the pericardial effusion is large and if it causes significant tamponade effects.
Intrapericardial fibrin-glue instillation Helpful in subacute cardiac tamponade. Intrapericardial fibrin-glue instillation
Helpful in subacute cardiac tamponade.

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