Dressler – s syndrome what are the causes of symptoms treatment

1 146 - Dressler - s syndrome what are the causes of symptoms treatment

1. Typical. Clinical manifestations of this form are associated with inflammation of the visceral pleura, pericardium and lung tissue. It includes combined and single variants of autoimmune damage to connective tissues:

  • pericardial – the parietal and visceral sheets of the pericardial sac are inflamed;
  • pneumonic – infiltrative disorders in the lungs are formed, leading to pneumonitis;
  • pleural – pleura becomes the target of antibodies, signs of hydrothorax develop;
  • pericardial-pleural – there are symptoms of sensitization of the pleura and serous membrane of the pericardium;
  • pericardial-pneumonic – the pericardial membrane and lung tissue are affected;
  • pleural-pericardial-pneumonic – from a heart bag, inflammation passes to the pulmonary and pleural structures.

2. Atypical. For this form, variants are characteristic due to the defeat of the joints and vascular tissues by antibodies. It is accompanied by an inflammatory process in large articular joints or skin reactions: pectalgia, “shoulder syndrome”, erythema nodosum, dermatitis.

3. Unsymptomatic (obliterated). In this form with mild symptoms, a fever, persistent arthralgia and a change in the composition of white blood are noted.

When diagnosing atypical and erased forms of the syndrome, some difficulties often arise that determine the relevance of the most in-depth study of this disease.

Causes

The post-infarction state has the following pathogenesis:

  • Myocardial infarction. With it, cardiomyocytes begin to die, which is accompanied by the development of specific antibodies to the body’s own cells. Damage is more susceptible to serous membranes. A pathologically altered protein of cardiomyocytes leads to the development of hypersensitivity of the body. The body converts its own cells into autoantigens, which, when interacting with antibodies, form into immune complexes. They are located in different organs and cause violations of their functions. The pleura of the pericardium and joints is also inflamed, fluid accumulates in these cavities, which is accompanied by unpleasant symptoms.
  • Surgery on the heart. Pathological disorders occur after cardiotomy or commissurotomy.
  • Cardiac muscle injuries, injuries, strokes.
  • Viral infections. The disease is found in people with an increased titer of anti-inflammatory antibodies.

Patients suffering from vasculitis, sarcoidosis, and scleroderma are at risk of developing such a complication.

The disease is an autoimmune process. This means that the problem is formed due to inadequate functioning of the body’s defense mechanisms. It was established that the occurrence of Dressler syndrome after a heart attack is provoked by the following cascade of reactions:

  1. Ischemic processes in the myocardium lead to a change in the normal structure of muscle tissue. With oxygen starvation, cells die, that is, necrosis is formed.
  2. Post-infarction syndrome develops in cases where the immune system does not respond correctly to dead elements of cardiac structures. Normally, individual sections of necrosis are surrounded by inflammation, however, pathological antigen-antibody complexes do not form.
  3. The onset of the disease can be compared with allergies. The body rejects dead cells, that is, it reacts to the protein contained in the tissues. However, in the case of Dressler’s syndrome, immune complexes are formed in response to damage to the body’s own cells. Their deposition leads to aggravation of inflammation, which affects not only muscle tissue, but also the pericardium, as well as serous membranes, lungs and even joints.

The most common cause of this autoimmune process is ischemic myocardial damage. That is why Dressler’s syndrome is called post-infarction. However, other factors are also able to provoke the development of the disease. The violation is formed as a complication of cardiological operations, with traumatic heart injuries, as well as with infection with some viral infections.

Thus, for the occurrence of Dressler syndrome, a damaging effect of heart tissue is required, which is accompanied by the development of inflammation. A change in the normal immune response to this process leads to the formation of a characteristic clinical picture.

At the initial stage of the study of the disease, Dressler made an assumption about the prevalence of the lesion. He hypothesized that an immunological disorder will occur in approximately 3-4% of patients who have previously had myocardial infarction. However, today the problem is diagnosed much less frequently.

The risk of suffering from the development of the pathology of the immune response persists in patients suffering from several disorders simultaneously, as well as in individuals who become infected with infectious pathologies during the rehabilitation period. There is evidence of a high likelihood of Dressler’s syndrome in a post-infarction state in people who previously underwent long-term therapy with Prednisolone and other corticosteroids. Presumably, patients with a third blood group and a negative Rh factor are more likely to encounter a similar complication.

Pericarditis and Dressler Syndrome

Pericarditis is an inflammation of the pericardial sac of a rheumatic, infectious or post-infarction character. Pathology is manifested by weakness, pain behind the sternum, which intensifies with inspiration and cough. For the treatment of pericarditis, bed rest is necessary. In the case of a chronic form of the disease, the regimen is determined by the condition of the patient.

In acute fibrinous pericarditis, symptomatic treatment is prescribed: anti-inflammatory non-steroid drugs, analgesics to eliminate the pain syndrome, medications that normalize the metabolic processes in the heart muscle, and more. With Dressler’s syndrome, treatment of pericarditis is carried out with drugs that eliminate the underlying disease.

With the syndrome, pericarditis develops. This condition is primarily manifested by pain, which occurs in seizures and can be of varying intensity. The condition improves when the patient takes an upright position. But as soon as you lie down, the pain intensifies, a cough appears, and breathing becomes deep.

Painful sensations bother constantly or periodically. In addition, the presence of:

  • pericardial friction noise, especially if the body is tilted forward. The severity of noise decreases when fluid is released into the pericardium;
  • fever. Body temperature rises no higher than 38 degrees. As a result of intoxication, the patient suffers from weakness, malaise, aching muscles and joints;
  • high levels of leukocytes, eosinophils, increased erythrocyte sedimentation rate;
  • shortness of breath, enlarged liver, swelling of veins in the neck. This indicates that the disease is severe;
  • superficial and frequent breathing, dry cough;
  • accumulation of fluid in the abdominal cavity;
  • swelling of the lower extremities.

The development of pericarditis in the syndrome is always observed. At the same time, the condition improves over several days.

Forms

This ailment has several different forms, having their own specific features, methods of diagnosis and treatment.

A typical (or expanded form of Dressler’s syndrome) is characterized by such signs as:

  • pleurisy (damage to the membrane of the lungs, as a symptom – pain in the lungs, cough of varying intensity);
  • (in other words: damage to the pericardium – the serous membrane of the heart muscle, the problem is that it is almost asymptomatic);
  • pneumonic form (the case when it affects the lungs in general)
  • pericardial-pleural (a more complex form in which both the pulmonary and cardiac membranes are affected, as well as complications of the state of the chest cavity);
  • pericardial-pneumonic syndrome (quite severe complications in the lungs, as well as damage to the lining of the heart);
  • pericardial-pleural-pneumonic form (one of the worst manifestations of post-infarction syndrome, as it is characterized by problems with all membranes: both the lungs and heart suffer, as well as the chest cavity and lungs in general);
  • pleuropneumonic form (a complication involving only the lungs).

Detonic – a unique medicine that helps fight hypertension at all stages of its development.

Detonic for pressure normalization

The complex effect of plant components of the drug Detonic on the walls of blood vessels and the autonomic nervous system contribute to a rapid decrease in blood pressure. In addition, this drug prevents the development of atherosclerosis, thanks to the unique components that are involved in the synthesis of lecithin, an amino acid that regulates cholesterol metabolism and prevents the formation of atherosclerotic plaques.

Detonic not addictive and withdrawal syndrome, since all components of the product are natural.

Detailed information about Detonic is located on the manufacturer’s page www.detonicnd.com.

Atypical

One form of Dressler Syndrome, which manifests itself as follows:

  • joint damage, there may be one or more, this form is called “articular”;
  • skin form, manifests itself in the form of various damage to the skin, for example: redness, irritation or rash.

Malosymptomatic

Perhaps the most difficult manifestation of the disease. It is not surprising, because the name speaks for itself, the symptoms are mild, respectively, the probability that the patient will pay attention and consult a doctor is reduced.

But, nevertheless, Dressler’s low-symptom form manifests itself as follows:

  • increased body temperature for a long time (it is very easy to confuse with many other diseases);
  • and other changes (the difficulty is that you can only notice with a medical examination);
  • and another manifestation that the patient himself can notice is joint pain.

Classifications PS based on several features. Based on this, Dressler’s syndrome has several forms.

  1. Typical. PS is manifested in the form of single or combined inflammation of the connective tissue. The form includes several types:
  • pleural – occurs rarely, but requires more serious treatment with the use of hormonal drugs;
  • pericardial – inflammation affects the membranes of the pericardial sac;
  • pneumonic – pneumonia develops as a result of structural changes in the lungs;
  • pericardial-pneumonic – changes affect the myocardial membrane and sections of the lungs;
  • pericardial-pleural – the serous membranes of the pleura and pericardium are destroyed;
  • pleural-pneumonic-pericardial – an inflammatory process occurs in the bag of the heart muscle and spreads to the tissues of the pleura and lungs.
  1. Atypical. Immune antibodies affect vascular and articular tissues. The syndrome is manifested by inflammatory processes of the skin (erythema, dermatitis), articular components and joints (“shoulder syndrome”, pectalgia).
  2. Unsymptomatic. The variety is manifested by mild signs, complicating timely diagnosis. The patient experiences pain in the joints and fever of the whole body.
  1. Early syndrome. Characteristic symptoms appear at 2 or 3 weeks after the onset of a heart attack.
  2. Late syndrome. The development of an autoimmune reaction occurs gradually and is expressed in the form of signs after 2 or more months from a completed attack.

Detailed

  • pleurisy (damage to the membrane of the lungs, as a symptom – pain in the lungs, cough of varying intensity);
  • pericarditis of the heart (in other words: damage to the pericardium – the serous membrane of the heart muscle, the problem is that it is almost asymptomatic);
  • pneumonic form (the case when it affects the lungs in general)
  • pericardial-pleural (a more complex form in which both the pulmonary and cardiac membranes are affected, as well as complications of the state of the chest cavity);
  • pericardial-pneumonic syndrome (quite severe complications in the lungs, as well as damage to the lining of the heart);
  • pericardial-pleural-pneumonic form (one of the worst manifestations of post-infarction syndrome, as it is characterized by problems with all membranes: both the lungs and heart suffer, as well as the chest cavity and lungs in general);
  • pleuropneumonic form (a complication involving only the lungs).

1 2 - Dressler - s syndrome what are the causes of symptoms treatmentPericardial-pleural form of dressler syndrome

Malosymptomatic

  • increased body temperature for a long time (it is very easy to confuse with many other diseases);
  • a high level of white blood cells and other changes (the difficulty is that you can only notice with a medical examination);
  • and another manifestation that the patient himself can notice is joint pain.

BOTTOM Line - Dressler - s syndrome what are the causes of symptoms treatment

Given the combination of lesions, these forms of the syndrome are distinguished:

  1. Typical. With it, the external membrane of the heart, lung tissue, and chest membrane are damaged. Various combinations may occur, for example, the pericardium and the membrane of the chest are damaged, and other variations are possible.
  2. Atypical. When autoimmune disorders develop in the synovial membranes of the joints and skin lesions, manifested by rash and redness.
  3. Unsymptomatic. In this case, the pathology is accompanied by low-grade fever for a long time, an increase in the erythrocyte sedimentation rate, an increase in the level of eosinophils, and pain in the joints.

Abdominal localization of the syndrome

The pathology of peritonitis, the inflammatory process in the internal lining of the cavity, is determined. It features a vivid clinical picture:

  • intense, excruciating abdominal pain. The strength of painful sensations decreases when finding a comfortable body position – most often lying on one side with bent legs;
  • impaired stool;
  • marked increase in temperature.

With the development of this form of the syndrome, it is urgent to differentiate the autoimmune form from the infectious form, which often acts as a consequence of digestive tract pathologies. The tactics of treatment, which most often implies the use of various groups of medicines, depend on the results of timely diagnosis.

Characteristic symptomatology

Post-infarction syndrome has manifestations in the form of intoxication, cardialgia, polyserositis. Patients noted the appearance of pain in the chest, decreased performance, weakness, fever and general malaise.

!  Heart tamponade what is it

The pain is characterized by a compressive and compressive character. It can spread to the left arm, shoulder, shoulder blade. Nitrates in this case are not able to alleviate the condition.

During the examination, the doctor observes that the patient has a pale skin, increased sweating, decreased blood pressure, and increased heart rate.

Auscultation shows the presence of muffled tones and a gallop rhythm. In this case, hospitalization is required.

In cardiology, several forms of the disease are described:

  1. A typical course of Dressler’s syndrome is associated with the development of inflammation in the cavity of the heart bag, lungs and joints. Pleura is also involved in the pathological process. This type of problem is most common.
  2. The atypical form of the disease is accompanied by damage to the joints, the development of skin manifestations of allergies, as well as the occurrence of asthma and peritonitis in the patient. In some cases, the symptoms of Dressler syndrome include inflammation of the kidneys, the inner surface of the vessels, and periosteum.
  3. In rare cases, clinical signs of pathology include hyperthermia amid an increase in the number of leukocytes in the blood, as well as an increase in ESR. In this case, the classic manifestations of the ailment are often not recorded, which greatly complicates the diagnosis of the problem. Then they talk about a low-symptom form of the disease.

The main clinical signs of Dressler’s syndrome that occur with a typical course of the disease include:

  1. The development of pericarditis, which occurs due to the accumulation of immune complexes in the heart bag. Against the background of this process, severe inflammation is noted, leading to severe pain. In addition, complaints of shortness of breath are recorded, as well as a visible increase in veins in the neck. Often, pericarditis is accompanied by swelling of the extremities and ascites. In the absence of adequate medical care, the risk of developing cardiac tamponade is great.
  2. Pleurisy is the second characteristic symptom of Dressler syndrome. It is customary to differentiate two types of pathology: dry and wet. In the first case, a characteristic noise of friction is diagnosed, which is felt by patients when breathing. Both halves of the chest can be affected, and only one. If exudate accumulates between the serous leaves, the pain becomes less intense. There is a muffled heart beat, cyanosis of the integument and a significant deterioration in well-being.
  3. Pneumonitis with Dressler syndrome is less common than pleurisy or pericarditis. The defeat of the lower parts of the lungs is characteristic. Patients have a strong cough, resulting in the discharge of sputum, often with impurities of blood. During auscultation of the respiratory system, moist rales are heard.

In most cases, a combination of several characteristic symptoms is noted at once. This is what allows doctors to suspect autoimmune pathology.

Characteristics

Dressler’s syndrome can be suspected on the basis of a visual examination and patient complaints within 2-3 months after myocardial infarction. To confirm the diagnosis, additional methods of laboratory and instrumental research are prescribed:

  1. Detailed clinical blood test. In the presence of pathology, an increase in the number of leukocytes in the blood, an acceleration of the erythrocyte sedimentation rate (ESR), an increase in eosinophils are observed.
  2. Biochemical blood test in combination with rheumatological tests, immunogram. The results reveal an increased amount of C-reactive protein, enzymes-markers of myocardial infarction (creatine phosphokinase, troponins).
  3. Electrocardiography It shows the localization of myocardial infarction, functional changes in the heart.
  4. Echocardiography. It shows the restriction of pericardial mobility and its thickening, the presence of fluid in the cavity (effusion). Defines areas of reduced myocardial contractility.
  5. Chest x-ray. It determines the thickening of the interlobar pleural regions during pleurisy, the amplification of the pulmonary pattern, the darkening during pneumonitis, and the enlargement of the heart during pericarditis.
  6. X-ray of the shoulder joints. Shows joint space, bone tissue compaction.
  7. Magnetic resonance imaging (MRI) of the chest. Assign to clarify the nature and determination of the extent of the lesion.

The development of Dressler syndrome is indicated by a previous myocardial infarction, as well as heart surgery or its traumatic injuries. To confirm the presence of a problem, a patient is examined, auscultation and percussion of the chest, during which characteristic signs of the disease are detected. Diagnose the formation of exudate in the heart bag and between the serous sheets of the chest cavity using x-rays.

Characteristic blackouts are visualized in the pictures, and signs of an increase in the borders of the heart are also noted. In some cases, in order to confirm the ailment, computed tomography is also used, which gives a clearer image.

Diagnosis of Dressler’s syndrome involves an ECHO. During the ultrasound, a characteristic accumulation of fluid is found, as well as a thickening of the pericardial leaves and the development of adhesions. To assess the nature of the exudate, a puncture is performed with the collection of contents for analysis. In order to determine the involvement of other internal organs in the process, laboratory tests are used.

The syndrome is named after the American doctor W. Dressler, who described it in 1965. In the cardiological literature, one can also find the terms “late pericarditis”, “post-infarction polyserositis”, “post-traumatic pericardial or post-cardiotomy syndrome.”

polnoe opisanie sindroma dresslera pochemu voznikaet simptomy kak lechit fc84fb5 - Dressler - s syndrome what are the causes of symptoms treatment

The appearance of post-infarction syndrome is associated with an atypical reaction of the immune system to the destruction that occurs in the structures of the heart muscle. Myocardial cell necrosis leads to the entry of destroyed particles into the bloodstream, through which they are carried throughout the body. As a result, autoantibodies are formed that are active against the protein components of the serous membranes of the affected organs.

According to statistics, among people who have had a heart attack, a similar complication occurs in 3-4% of cases. But taking into account atypical forms of manifestation, the figure is from 15 to 30%.

A patient after a heart attack should be observed by a cardiologist and independently monitor their well-being. If you suspect complications, you must seek medical help.

During the diagnosis, the doctor takes into account the features of the transferred attack, as well as the localization of surgical intervention. On examination, sounds in the lungs, their strength and sonority, cough, friction noise of the pericardium or pleura, the sound of heart sounds are revealed.

To confirm the diagnosis, a number of laboratory and instrumental examinations are prescribed. They include:

  • a blood test to identify the erythrocyte sedimentation rate and a description of the leukocyte formula to detect an elevated white blood cell count;
  • general urine analysis with additional detection of protein and sediment;
  • blood test for the preparation of a biochemical profile;
  • taking an electrocardiogram with the study of dynamic changes;
  • radiography of the chest and joints of the shoulder girdle (according to indications) to detect signs of pleurisy and pneumonitis;
  • echocardioscopy to detect a decrease in arbitrary areas in individual sections of the heart muscle, as well as the presence of fluid in the cavities;
  • tomographic examinations in difficult to diagnose cases;
  • Ultrasound of the internal organs;
  • taking puncture in case of insufficiency of cardiac or pulmonary function.

We continue to describe Dressler’s syndrome after myocardial infarction. What is it is now clear. However, the situation is described only in the general case, it is better for each specific person to consult with the attending physician. When diagnosing this complication of a heart attack, patient complaints, characteristic clinical symptoms and the results of a comprehensive instrumental and laboratory examination are taken into account. Valuable diagnostic parameters that give a complete picture of the patient’s condition include:

  1. Clinical criteria. Symptoms that confirm the high likelihood of the development of Dressler polyserositis are febrile fever and pericarditis.
  2. Laboratory research. In the KLA are possible: eosinophilia, leukocytosis, increased ESR. In addition, a blood test is performed on markers of damage to the heart muscle. An increase in the level of globular proteins – troponin T and troponin I – and confirms the fact of cell death.
  3. In the diagnosis of Dressler syndrome, an ECG is often used, on which negative dynamics are noted. The most typical symptom is unidirectional movement of the ST segment in several leads.
  4. Ultrasound of the pericardium and pleural cavities.
  5. Chest x-ray. With the development of pleurisy, the interlobar pleura thickens, with pericarditis, the heart shadow expands, with pneumonitis, blackouts in the lungs are determined. In some cases, cardiomegaly is clearly visible in Dressler’s syndrome after a heart attack.
  6. In unclear diagnostic situations, MRI of the lungs and heart is prescribed.

In the absence of high-quality and timely diagnosis and medical assistance, Dressler’s syndrome can lead to the development of constructive or hemorrhagic pericarditis (the appearance of bloody exudate or compression of the heart tissue), and in more advanced cases, it causes serious cardiac tamponade.

To determine Dressler’s syndrome after a heart attack:

  1. Collect patient history. The doctor interviews for complaints, determines when the first signs appeared, and finds out whether there have been any cases of the development of such pathologies in the family.
  2. Perform a physical examination. It consists of determining the color and appearance of the skin, analyzing respiratory movements, measuring pressure in the arteries, listening to heart sounds and checking body temperature.
  3. Donate blood and urine for a general analysis. In this case, the blood composition, cell level, erythrocyte sedimentation rate and other indicators are determined.
  4. Take a biochemical blood test. It will provide information on cholesterol and glucose levels.
  5. Take electrocardiography and echocardiography.
  6. Take an x-ray of the chest cavity.
  7. Take magnetic resonance imaging and CT

You may also need to consult a physician.

In order to confirm or refute the diagnosis, the diagnosis of Dressler syndrome is necessary, this can be done thanks to a number of special procedures:

  • analysis of the history of complaints. The doctor must first identify what worries the patient, whether he had a heart attack, when there were chest pains and so on.
  • life history. The specialist reveals whether there were any external irritants, the presence of chronic diseases, operations, etc.
  • family history. In this case, the presence of such diseases in the family is detected;
  • after the specialist starts a direct examination of the patient, checks the skin, measures body weight and temperature;
  • the next step is listening to the heart and lungs, and usually, weakening of breathing on the affected side is detected;
  • one of the important elements of diagnosis is the general analysis of blood and urine. The specialist draws attention to pathological changes in their composition (for example: leukocytosis);
  • among other things, you need to determine the level of sugar and cholesterol in the blood, this is done thanks to a biochemical blood test;
  • electrocardiography (ECG of the heart), thus, the doctor will detect the presence of pericarditis in the patient.
  • chest x-ray, as one of the methods of diagnosis, is needed in order to detect compaction of the pulmonary membrane, focal shadow or an increase in heart shadow
  • One of the most effective procedures for identifying post-infarction syndrome is considered to be magnetic resonance imaging (MRI).

1 147 - Dressler - s syndrome what are the causes of symptoms treatmentListening to the heart

Complications of this pathology

Treatment takes place in an inpatient setting. Emergency care for Dressler’s syndrome, as a rule, is not required, since there is no obvious threat to life. However, if treatment is started sooner, the chances of recovery are significantly increased.

The main role in the spectrum of therapeutic measures for Dressler’s post-infarction syndrome is played by drug therapy, which has several goals and involves the use of multidirectional drugs:

  1. Cardiotropic, which help eliminate heart disorders. These are the medicines used in the treatment of coronary heart disease: beta-blockers, antianginal drugs, nitrates, calcium channel blockers, cardiac glycosides.
  2. Anti-inflammatory. In the case of resistance to NSAIDs, short courses of glucocorticoid administration are given. In severe forms of the disease, medicines of other groups are used (Methotrexate, Colchicine).

Anticoagulants due to the increased likelihood of developing hemopericardium during treatment after a heart attack are not used. If necessary, their use is prescribed subtherapeutic dosage. In each individual case, the treatment of this pathology is selected individually. With severe pain, intramuscular administration of analgesics is indicated.

The occurrence of complications in the post-infarction period is very rare. In isolated cases, patients suffered from kidney pathologies in the form of glomerulonephritis and vascular diseases, such as hemorrhagic vasculitis.

In rare cases, if hormone therapy has not been carried out, effusion pericarditis becomes adhesive. It complicates the process of relaxation of the heart muscle and causes stagnation in a large circle of blood circulation. This leads to the development of diastolic heart failure.

!  Heart palpitations what to know and how to treat

In post-infarction syndrome, relapses alternate with remissions. The weakening of the manifestations of the pathological process is observed during treatment, as soon as it is stopped, the condition worsens. Each relapse can last from a week to several months.

Dressler’s syndrome is a complication that has a favorable prognosis. With this diagnosis, the patient is issued a sick leave. It indicates that a person has lost working capacity for a period of 3–3,5 months. If the condition does not improve, then this period is extended.

Persistent disability and the appointment of a patient with a disability group are indicated when frequent relapses are observed, serious disorders in the cardiovascular system have occurred, which are associated not only with pathology, but also with myocardial infarction.

As a rule, Dressler’s post-infarction syndrome has positive predictions, the disease proceeds without serious consequences. In rare cases, the patient may lose working capacity due to private relapses. In addition, the consequences occur with not the right treatment, and even more so, in the absence of it.

Sometimes the disease even after treatment proceeds according to the principle: relapse – remission, with a duration of relapse of about 1 month.

Lethal outcomes, fortunately, are minimized. Especially given the high effectiveness of drugs for treating the syndrome.

But, even taking into account all the positive prognoses, the patient must remember that he must clearly follow the instructions of his doctor in order to minimize the risks of complications and save himself from serious consequences.

At the moment, medicine has made good progress in the treatment of heart diseases, including myocardial infarction, which means that the likelihood of developing complications is much lower than 10-15 years ago.

Dressler’s syndrome is one of the many complications of myocardial infarction. This can be pneumonitis, pleurisy, pericarditis, arthritis, fever, leukocytosis, an increase in the erythrocyte sedimentation rate and other diseases.

As a rule, Dressler’s post-infarction syndrome has positive predictions, the disease proceeds without serious consequences. In rare cases, the patient may lose working capacity due to private relapses. In addition, the consequences occur with not the right treatment, and even more so, in the absence of it.

Dressler’s post-infarction syndrome (DM) develops with extensive or complicated forms of myocardial infarction (MI). The risk of developing pathology decreases with timely hospitalization and thrombolysis therapy. The incidence of the syndrome on average is 1-3% of the total number of all heart attacks.

After treatment, the prognosis is favorable. Temporary disability for a disease is determined for a period of 3 to 4 months, in the presence of complications – up to six months. Disability is established with frequent relapses, a high degree of impaired functioning of the affected organ system. As a rule, multiple concomitant pathologies and complications lead to permanent disability.

From this article you will learn: what is Dressler’s syndrome, how does this post-infarction complication develop. Causes of occurrence, risk factors, main symptoms. Treatment methods and prognosis for recovery.

Dressler’s syndrome is an autoimmune complication that develops some time later (from 1 to 6 weeks) after a heart attack.

What happens with pathology? Myocardial infarction is an attack of acute ischemia (oxygen starvation) of the cells of the heart muscle (cardiomyocytes), as a result of which they die. In their place, a site of necrosis is formed, and then a scar from connective tissue. In this case, a specific protein (pericardial and myocardial antigens) enters the bloodstream – the result of the cellular breakdown of cardiomyocytes.

As a result, all protein structures with a similar structure (located mainly in the cell walls) are attacked by the immune system of their own body.

This is how an autoimmune reaction develops to healthy cells and body tissues.

Pathology affects synovial articular bags, pleura, pericardium and other organs, causing a variety of inflammation of the connective tissue of an aseptic nature (aseptic – that is, without the participation of viruses and bacteria):

  1. Pericarditis (inflammation of the serous membrane of the heart).
  2. Pleurisy (inflammation of the serous membrane of the lungs).
  3. Pneumonitis (aseptic pneumonia).
  4. Autoimmune arthritis of the shoulder joint (joint inflammation).
  5. Peritonitis (inflammation of the peritoneum).
  6. Skin manifestations as allergic (urticaria, dermatitis, erythema).

Postinfarction syndrome itself is not life threatening even in the most severe course (protracted, often repeated form), worsens the patient’s quality of life and working capacity temporarily (a sick leave certificate is issued for a period of 3 months).

Autoimmune diseases, including post-infarction syndrome, in most cases become chronic (85%) and tend to recur (return). Only in 15% of cases the disease is completely cured.

The patients with Dressler’s syndrome are monitored and treated by a cardiologist.

The autoimmune reaction is directed to the protein structures of cell membranes located mainly in the membranes of the organs (pleura, pericardium, synovial bags of joints, sometimes peritoneum, skin). The body produces lymphocytes that bombard healthy cells, trying to destroy them (destroy, dissolve).

Connective tissue becomes inflamed, causing organ malfunctions, pain and various symptoms (cough with pleurisy).

Dressler’s syndrome develops some time after a heart attack. Symptoms may appear one week (early) or 8 months (late) after the attack, but usually begin at 2-6 weeks.

  • in the form of short acute periods (from 2 to 5 weeks, with severe symptoms) and months-long periods of remission (signs of the disease are greatly erased or do not appear at all) – 85%;
  • in the form of an acute period (from 2 to 6 weeks), which is replaced by a full recovery – 15%.

Causes of appearance

sindrom dresslera6 - Dressler - s syndrome what are the causes of symptoms treatment

The reason for the appearance of Dressler syndrome is foci of necrosis as a result of:

  • focal or complicated myocardial infarction;
  • cardiac surgery;
  • catheter ablation (cauterization of the site of the myocardium with an electrode);
  • severe and penetrating chest injuries.

In 98% of cases, it is diagnosed as a post-infarction complication.

Risk Factors

Factors that can increase the risk of pathology may include:

  1. Autoimmune diseases (collagenoses, vasculitis).
  2. Sarcoidosis (lung cancer).
  3. Spondylarthrosis (degenerative joint damage).
  4. Idiopathic (for no apparent reason) or viral pericarditis (inflammation of the outer lining of the heart).

At the stage with severe symptoms, it is difficult for the patient to perform the most basic everyday actions, the quality of life is greatly deteriorating, the recovery period after a heart attack is much delayed.

During periods of persistent remission, disability is restored as much as the severity of the heart attack allows.

1 1 147 - Dressler - s syndrome what are the causes of symptoms treatment

Symptoms largely depend on where the autoimmune inflammatory process is located.

Symptom Group Description
General symptomsIncrease in temperature (from 37 to 39 ° C) Aseptic inflammation of the serous membranes (outer shells of organs from connective tissue) Pain General weakness, poor health Change in blood count (eosinophilia, leukocytosis)
With pericarditisChest pain increases with a strong breath, passes in a sitting position (leaning forward) Increased (39 ° C) or low-grade fever (37 ° C), shortness of breath, swelling of the cervical veins, fluid may accumulate in the pericardial cavity (serous membrane of the heart)
With pleurisyChest pain, localized on the left and behind, dry cough (which often goes away after 3-4 days), high fever
With pneumonitis“Spilled” pain in the chest, fever (temperature jumps from 37 to 38 ° C), dry, debilitating cough (sometimes with streaks of blood), shortness of breath after any physical effort
For arthritis of the shoulder joint (“arm and shoulder syndrome”)Fever (temperature changes from 37 to 39 ° C), pain, impaired sensitivity, swelling, redness of the shoulder joint (left or both), swelling of the fingers or hand Pale, bluish skin of the affected arm
With skin manifestations (Dressler’s syndrome, atypical form)Rashes on the skin in the form of urticaria, dermatitis, erythema, itching surface, small rash, increase in local temperature, bright red spots Fever and pain, no characteristic changes in blood count (eosinophilia, leukocytosis)
With perichondritis and periostitis (inflammation of the periosteum and perichondrium of the articular joints) of the anterior chest wallSwelling and pain in the sternoclavicular joint, which intensifies after pressure There are no other characteristic symptoms (fever, changes in blood count)

Pleurisy

Pleurisy is the inflammatory process of the membrane that covers the lungs and chest. In this case, a person has difficulty breathing, the body temperature rises, pain in the chest area worries, it seems as if something is scratching inside.

Pleurisy can occur in dry, wet, unilateral and bilateral forms.

Pneumonitis

This diagnosis is made if the lung tissue is inflamed. In this case, the patient suffers from:

  • pain behind the sternum;
  • shortness of breath;
  • dry or wet cough with blood in the sputum.

With pneumonitis, the inflammatory process affects the lower lobes of the lungs.

Less often with Dressler’s syndrome, joints and blood vessels are found. Arthritis may occur in which a person experiences pain and mobility restrictions, numbness and flushing of the skin. Edema of the interphalangeal joints and hands is sometimes observed.

Clinical guidelines for Dressler syndrome

The classic triad of the disease includes inflammation of the pericardium (pericarditis), pleura (pleurisy) and lung tissue (pneumonitis or pulmonitis). In addition, damage to the joints and skin is often joined. General clinical manifestations are characterized by the following symptoms:

  • persistent low-grade fever (37-38 ° C);
  • chest pain
  • cough;
  • shortness of breath;
  • polymyositis;
  • signs of intoxication (headache, tachycardia, decreased blood pressure);
  • spondylarthrosis;
  • rash;
  • skin redness;
  • paresthesia;
  • pallor of the skin.

Pericarditis

The main manifestation of pericardial inflammation is pressing pain, which can be mild, severe or paroxysmal. As a rule, it weakens when the patient is standing and amplifies when he is lying. Symptoms of pericarditis often have a mild course, subside and disappear after a few days. In addition to pain, inflammation of the pericardium is characterized by the following symptoms:

  • pericardial friction noise heard during auscultation;
  • fever;
  • weakness;
  • malaise;
  • muscle aches;
  • heart palpitations;
  • dyspnea;
  • ascites (accumulation of flu >Bot Adr ug - Dressler - s syndrome what are the causes of symptoms treatment

There are several forms of pleurisy: dry (without effusion), wet (with effusion), one-sided or two-sided. Provoking factors for the development of inflammation of the interstitial tissue are smoking, hypothermia, or colds. Exacerbation of pleurisy can last up to two weeks. Inflammation of the pleura is characterized by the following symptoms:

  • chest pain, worse when inhaling;
  • cough;
  • fever;
  • a feeling of scratching in the chest;
  • asthma attacks;
  • inspiratory (on inspiration) shortness of breath.

Pneumonitis

This is an autoimmune inflammation of the lung tissue, the foci of inflammation of which are mainly located in the lower segments of the lungs. Pneumonitis exacerbates, usually in the cold season, under harmful working conditions or adverse environmental conditions. Inflammation is manifested by the following symptoms:

  • retrosternal pressing pain;
  • shortness of breath;
  • dry or wet cough;
  • bloody sputum.

Joint damage

With post-infarction syndrome, large joints are affected (shoulder, hip, elbow). Exacerbations often provoke hypothermia or prolonged heavy physical exertion. The acute period lasts from 5 to 10 days. In this case, patients present such complaints:

  • redness of the skin around the joint;
  • swelling of the joint;
  • paresthesia;
  • numbness of limbs;
  • perichondritis (perichondrium damage);
  • disorders of blood supply to the joints;
  • pain during movement;
  • nightly aching pains.

An autoimmune inflammatory skin lesion joins the classical triad of clinical manifestations of the syndrome rarely, usually in the absence of treatment in combination with other symptoms. The following symptoms appear:

Sometimes the disease proceeds with almost no clinical symptoms. You can suspect the presence of autoimmune damage to the connective tissue in the presence of the following symptoms:

  • prolonged fever of unclear etiology;
  • arthralgia;
  • increased erythrocyte sedimentation rate (ESR), white blood cells and eosinophils in a clinical blood test.

In order to reduce the risk of developing this disease, it is necessary to carefully consider all the emerging symptoms associated with heart disease. Since the initial cause of the development of Dressler’s syndrome is myocardial infarction, preventive measures should first of all be aimed at preventing the development of this acute condition.

Lifestyle adjustment

After myocardial infarction, the usual activity and lifestyle of a person is significantly limited. Therefore, it is necessary to make changes in nutrition and daily routine to prevent the development of relapse. The patient should:

  1. Avoid excessive physical exertion. They enhance the work of the heart, and in connection with post-infarction changes, this causes an attack of oxygen starvation and severe complications. But you can not completely abandon the sport. Moderate exercise will help restore heart muscle faster. It is useful to walk in the fresh air, do aerobics.
  2. Refuse harmful products that increase cholesterol and cause atherosclerosis. Patients should avoid fatty and fried foods, eat more vegetables, fruits.
  3. Keep track of your weight. If there are extra pounds, this problem must be solved, but debilitating diets are prohibited.
  4. Exclude alcohol and smoking.
  5. Avoid emotional upheaval, stress, sudden changes in climatic conditions.

Compliance with these recommendations will avoid a second attack and reduce the risk of complications.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

Detonic