Dressler – s syndrome – what is it, symptoms, treatment and prevention

The pathogenesis of Dressler’s syndrome is not fully understood. Only the fact that the nature of the disease is autoimmune is clearly known. For an unknown reason, immune cells begin to perceive body tissues as strangers and attack them.

There are several theories that explain violations that occur. According to the first, after a myocardial infarction, many protein breakdown products enter the bloodstream.

The body produces antibodies whose purpose is to bind circulating antigens. The resulting complexes settle on the surface of various organs.

Therefore, their elimination by the body’s defenses is accompanied by tissue damage.

According to the second theory, many organs have antigens resembling myocardial, pericardial. Protective cells do not notice differences; they begin to attack both antigen-antibody complexes and ordinary tissues.

Dressler’s syndrome has very different manifestations. There are 3 main forms of pathology:

  • Typical (detailed). It manifests itself as pericarditis, pneumonia, polyarthritis, pleurisy. All inflammatory processes can occur individually (less often) or form various combinations.
  • Atypical. Its symptoms are arthritic, skin, cardio-shoulder-chest, peritoneal, asthmatic syndromes.
  • Unsymptomatic. The main manifestations are fever, joint pain, an increase in the number of white blood cells, eosinophils, ESR.

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Causes

The main cause of post-infarction syndrome is myocardial infarction. However, doctors are not in vain insisting on the use of the term “heart damage syndrome”. Indeed, the development of Dressler syndrome is accompanied by the death of myocardial cells of any nature. Damage to the heart muscle may be due to:

  • open chest injury (gunshot, stab wound);
  • cardiological operations;
  • catheter ablation (cauterization of the heart muscle with an electrode).

The risk factors for the development of pathology include:

  • other autoimmune diseases;
  • lungs’ cancer;
  • spondyloarthrosis;
  • inflammation of the heart bag (pericarditis).

Signs, symptoms

The classic clinical picture develops at 2-4 weeks. However, signs of the disease may appear earlier (early diabetes) or much later (late diabetes).

Typical Dressler’s syndrome is manifested by fever, pericarditis, pleurisy, pneumonia, polyarthritis. Fever does not have typical features. The temperature is usually slightly increased, less often or absent. In a particular patient, the symptoms of Dressler’s syndrome will depend on the localization of the inflammatory process.

Manifestations of typical autoimmune processes in diabetes.

PericardiumMandatory element of the classic form. The pain syndrome is localized behind the sternum. The pain is acute paroxysmal or pressing. Strengthens with coughing, swallowing, breathing. It weakens if the patient is standing or lying on his stomach. After a few days, fluid accumulates in the pericardial cavity, the pain disappears.
PleuraPain on the sides of the chest, which intensifies during breathing, shortness of breath. May be asymptomatic.
LungsPneumonia is less common pericarditis, pleurisy. It is manifested by weakened, hard breathing, the appearance of wheezing, coughing, sputum production. Sputum may contain blood impurities.
JointsMost often, the shoulder joint is affected, especially the left. Signs of arthritis are pain, limited mobility.

Atypical forms may occur:

  • urticaria, dermatitis, redness of the skin;
  • paroxysmal shortness of breath (without coughing);
  • nausea, vomiting, tenderness of the abdomen.

Diagnostics

The diagnosis of Dressler’s syndrome is established by the combination of symptoms, results of a clinical, instrumental, and laboratory examination. After listening to the patient’s complaints, the doctor will definitely conduct a chest auscultation.

Typical noises indicate the presence of inflammatory processes. Their absence does not give reason to exclude the disease, since exudative forms most often occur secretly.

In this case, inflammation can only be detected using visual diagnostic methods.

Features of auscultation in post-infarction syndrome.

PericarditisAt the beginning of the disease, the noise of pericardial friction, reminiscent of a crunch of snow, is heard. It intensifies if you hold the stethoscope tightly, hold your breath or take a knee-elbow position.
PleurisyBreathing shallow, rapid. With dry pleurisy, pleural friction noise is heard. It is very delicate, resembling a rustle of leaves or rough, like a crunch of snow. The accumulation of exudate is accompanied by the disappearance of extraneous sounds.
PneumoniaSmall bubbling rales, hard breathing.

SD is an indication for the following tests:

  • Blood analysis. Often there is an increase in ESR, C-reactive protein level, an increase in the number of leukocytes, eosinophils.
  • Electrocardiography ECG changes are recorded only in the presence of pericarditis.
  • Ultrasound of the heart. It can reveal a thickening of the leaves of the pericardium, an increase in the space between them. The cavity of the heart bag sometimes contains a small amount of fluid.
  • Chest X-ray, MRI or CT. Visual diagnostic methods allow you to see the accumulation of fluid, the presence of characteristic changes in the structure of the lungs, pleura.
  • Pleural, pericardial puncture. With a special needle, the doctor sucks the contents of the pleural, pericardial cavity. The characteristic signs of inflammation are the presence of a large number of eosinophils, white blood cells, and a high level of C-reactive protein.

Dressler syndrome treatment does not require mandatory hospitalization. It is indicated for patients with:

  • the spread of typical manifestations;
  • severe relapse of diabetes;
  • unsuccessful therapy of the disease;
  • fever, skin manifestations, if myocardial infarction is recent.

Dressler’s syndrome is treated with drugs that suppress the immune response, as well as drugs that eliminate the symptoms.

The main groups of drugs for the treatment of diabetes.

Group Name/Representatives

Nonsteroidal anti-inflammatory drugs (NSAIDs)Ibuprofen, aspirinEliminate inflammation, remove pain, reduce temperature.
GastroprotectorsOmezProtect the mucosa of the digestive tract from NSAIDs.
GlucocorticoidsPrednisone, dexamethasoneEliminate inflammation, prevent the development of allergic reactions, contribute to the inhibition of autoimmune processes.
Tropolon alkaloidColchicineIt has a powerful anti-inflammatory effect. It is prescribed to patients for whom glucocorticoids, NSAIDs are contraindicated.
AntimetabolitesMethotrexateIt inhibits the body’s immune responses.
AnticoagulantsClopidogrelThey are rarely prescribed because of the risk of developing hemopericardium. Prevent blood clots.

Surgical treatments for Dressler’s syndrome are rarely used. They are indicated for patients at high risk of developing life-threatening complications. The essence of all operations is to remove the accumulated fluid from the pleural or pericardial cavity. This is achieved by the following procedures:

  • pericardiocentesis – puncture, aspiration of the contents of the heart bag;
  • pericardectomy – complete or partial removal of the pericardium. A complex procedure, the indication for which is compression of the heart by the accumulated fluid (cardiac tamponade);
  • puncture of the pleural cavity – aspiration of the contents of the cavity with a special syringe followed by the introduction of drugs that contribute to recovery.

Prevention

Specific methods for the prevention of post-infarction syndrome have not yet been developed. Comprehensive treatment of myocardial infarction can minimize the likelihood of developing diabetes, but does not completely prevent it.

It is proved that the use of NSAIDs, glucocorticoids during the acute, subacute phase of a heart attack is ineffective. A COPPS study (Colchicine for the Prevention of Post-pericardiotomy Syndrome) is currently being conducted, studying the feasibility of using colchicine as a prophylactic.

Dressler’s post-infarction syndrome is rarely accompanied by complications. Their presence complicates the recovery from a heart attack, worsens the quality of life. Most complications are treatable. Launched processes can lead to irreversible disruption of the heart – chronic heart failure. Very rarely, complications of diabetes are fatal.

The main types of complications of diabetes.

Heart tamponadeSqueezing the heart with fluid injected between the leaves of the pericardium.
Hemorrhagic pericarditisThe accumulation of blood inside the heart bag. It leads to compression of the heart.
Constrictive pericarditisInflammation of the pericardium, accompanied by a thickening of its leaves, narrowing of the lumen of the pericardial cavity. It leads to compression of the heart.
Adhesive PericarditisThe formation of screeds, adhesions between the wall of the heart and the leaves of the pericardium. It is dangerous to develop a “shell-shaped heart” – a pathology in which the heart appears inside an inelastic pericardium, cannot fully contract, relax.
Occlusion of the coronary shuntDeterioration of patency of the coronary shunt.
AnemiaReduced hemoglobin and/or red blood cells.
glomerulonephritisInflammation of the renal glomeruli.
Aseptic Acute HepatitisAcute inflammation of the liver.

Forecast

The prognosis for Dressler syndrome is favorable. The quality, life expectancy of a person is more dependent on the success of recovery after myocardial infarction. However, there is evidence that the transferred disease slightly worsens survival for 5 years (4).

In some patients, diabetes cannot be completely cured. Pathology goes into a latent stage with recurrent relapses. Such patients have to undergo lifelong treatment of post-infarction syndrome for life or take drugs constantly.

There are several theories that explain violations that occur. According to the first, after a myocardial infarction, many protein breakdown products enter the bloodstream. The body produces antibodies whose purpose is to bind circulating antigens. The resulting complexes settle on the surface of various organs. Therefore, their elimination by the body’s defenses is accompanied by tissue damage.

Causes

Post-infarction syndrome occurs due to disorders in the immune system. Cells of the heart muscle begin to be perceived by the immune system as foreign. Immunity begins to work against its own organism. This condition is considered as pathological. Post-infarction syndrome occurs with a frequency of 3-4% in patients with myocardial infarction.

The risk of Dressler’s syndrome increases with extensive, complicated, or repeated myocardial infarction. The cause of the formation of the syndrome may be surgery on the heart. However, the frequency of development of this pathology as a complication of MI in connection with an improvement in the quality of treatment of patients has recently been reduced.

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).

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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

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.

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)

Rarely occurring forms of Dressler’s syndrome – peritonitis, vasculitis (inflammation of the vascular walls), synovitis (inflammation of the internal capsule of the joint) – are characterized by the same symptoms as the rest of the processes (fever, pain, depending on the localization of the process, worsening of well-being, change in blood count).

2How is postinfarction syndrome manifested

Postinfarction syndrome or Dressler’s syndrome is manifested by the following symptoms and signs:

  1. Pericarditis
  2. Pleurisy
  3. Pneumonitis
  4. Raising body temperature to 39 degrees
  5. Increased blood eosinophils
  6. ESR Acceleration
  7. Synovitis
  8. Rashes on the skin in the form of urticaria, eczema, etc.
  9. General weakness and malaise

The simultaneous development of all these symptoms is very rare. As a rule, certain of the above syndromes prevail.

1) Pericarditis – inflammation of the leaves of the heart bag. This is the most common manifestation of Dressler syndrome, which is characterized by:

  • Dull, pressing pain in the heart
  • The pain is aggravated by a deep breath, coughing, leaning forward, tilting or tilting the head. It decreases in a half-sitting position and lying on your back.
  • Pain can spread to the neck muscles. There is no effect of taking nitroglycerin.

The accumulation of fluid in the pericardial cavity leads to a decrease in pain and the appearance of shortness of breath.

Dressler’s syndrome – pleurisy

2) Pleurisy – inflammation of the pleura. The pathological process can be located on one or two sides. Inflammation can occur without fluid accumulation in the pleural cavity. Then the main symptoms will be:

  • Pain in the chest area, which intensifies with coughing, deep breathing, chest movements.
  • Pain is relieved by limiting chest mobility.

3) Pneumonitis is a post-infarction condition that is much less common. It is characterized by inflammatory foci in the lungs. With pneumonitis, the following symptoms appear:

  • Cough that may be accompanied by bloody sputum
  • Bilateral chest pain

4) Synovitis – inflammation of the synovial membrane of the joints. It manifests itself as pain in the joints. Often, the pathological process is localized in large joints – elbow, shoulder, wrist.

5) Laboratory changes in blood tests indicated above.

For the clinical course of Dressler’s syndrome, a relapsing course is characteristic. This means that the syndrome can resume in 2-3 weeks and last up to 1 month.

3 Diagnosis of the syndrome

ST segment lift

Diagnosis of the syndrome is based on complaints, clinical examination. Already at the stage of percussion and auscultation, a specialist may suspect the presence of this pathology in the patient. Diagnosis of the syndrome is supplemented by laboratory and instrumental methods. So, the main criteria for the diagnosis of post-infarction syndrome are the following signs:

  • Pericardial Friction Noise During Auscultation
  • ECG changes as ST segment elevation
  • Changes in the leaves of the pericardium, fluid in the pericardial cavity
  • Pleural friction during auscultation
  • X-ray signs of pleurisy and pneumonitis
  • Ultrasound diagnosis of fluid in the pleural cavity

Computed tomography or magnetic resonance imaging can be performed as clarifying diagnostic methods in unclear cases that complicate the diagnosis of post-infarction syndrome.

Signs, symptoms

LocalizationManifestations
PericardiumMandatory element of the classic form. The pain syndrome is localized behind the sternum. The pain is acute paroxysmal or pressing. Strengthens with coughing, swallowing, breathing. It weakens if the patient is standing or lying on his stomach. After a few days, fluid accumulates in the pericardial cavity, the pain disappears.
PleuraPain on the sides of the chest, which intensifies during breathing, shortness of breath. May be asymptomatic.
LungsPneumonia is less common pericarditis, pleurisy. It is manifested by weakened, hard breathing, the appearance of wheezing, coughing, sputum production. Sputum may contain blood impurities.
JointsMost often, the shoulder joint is affected, especially the left. Signs of arthritis are pain, limited mobility.

4 Treatment of post-infarction syndrome

Treatment of post-infarction syndrome can be carried out by the following groups of drugs:

  • Acetylsalicylic acid from the group of drugs that prevent platelet adhesion.
  • Ibuprofen from the group of non-steroidal anti-inflammatory drugs.
  • Glucocorticoid drugs – a group of drugs that are reserve drugs. They are used only with resistance to previous drugs. The use of glucocorticoid drugs can slow the healing processes of myocardial infarction.

If there is a large amount of fluid in the pleural cavity, surgical methods for its removal can be used.

Diagnostics

The diagnosis of Dressler’s syndrome is established by the combination of symptoms, results of a clinical, instrumental, and laboratory examination. After listening to the patient’s complaints, the doctor will definitely conduct a chest auscultation. Typical noises indicate the presence of inflammatory processes. Their absence does not give reason to exclude the disease, since exudative forms most often occur secretly. In this case, inflammation can only be detected using visual diagnostic methods.

diseaseNoise characteristics
PericarditisAt the beginning of the disease, the noise of pericardial friction, reminiscent of a crunch of snow, is heard. It intensifies if you hold the stethoscope tightly, hold your breath or take a knee-elbow position.
PleurisyBreathing shallow, rapid. With dry pleurisy, pleural friction noise is heard. It is very delicate, resembling a rustle of leaves or rough, like a crunch of snow. The accumulation of exudate is accompanied by the disappearance of extraneous sounds.
PneumoniaSmall bubbling rales, hard breathing.

ST segment lift

Holter ECG Monitoring

Post-infarction angina pectoris may be suspected in establishing a connection with the fact of myocardial infarction. The following methods can be used in the diagnosis of post-infarction angina pectoris:

  1. ECG
  2. Stress tests
  3. Daily Holter ECG Monitoring
  4. Heart ultrasound
  5. Coronary angiography

5 Early post-infarction angina

Another common complication of myocardial infarction is early post-infarction angina pectoris. This is a pathological condition that develops in the first 2 weeks after MI in people older than 50 years. Most often, angina pectoris develops after an unexpanded myocardial infarction.

Modern treatments

Dressler’s syndrome, also called post-infarction syndrome, is a form of complication of myocardial infarction. It occurs as a reaction of the body’s immunity to its own organs and tissues (autoimmune disorder).

May have signs of pericarditis, pleurisy, pneumonitis, arthritis, fever, leukocytosis. The most common “bouquet” of pathologies: inflammation of the membranes of the heart, lungs and chest walls, as well as the lungs themselves.

Sometimes accompanied by damage to the synovial membranes of the joints.

The syndrome was first described in 1956 by the American physician W. Dressler, in whose honor the phenomenon is named. By the similarity of symptoms, the disorder is often confused with other cardiac lesions. Therefore, myocardial infarction is more classified as post-infarction Dressler’s syndrome or post-injury heart syndrome.

Causes

Dressler’s syndrome develops 15-20 days after the occurrence of myocardial infarction (1-3% of cases). More often it occurs in the near future after heart surgery, accompanied by the opening of the pericarditis cavity (35-50% of cases).

The main reasons are called:

  • extensive heart damage;
  • cell death and oxygen starvation of the muscle layer of the heart, as a result of which autoimmune reactions to altered proteins occur, as to foreign bodies.

39b8a60c8bca60d917e484b59e2a3f28 - Dressler - s syndrome - what is it, symptoms, treatment and prevention

And yet, of all heart diseases, it is myocardial infarction that is isolated as the main cause of the disorder.

Evidence

Symptoms appear gradually, one after another. A classic case of the syndrome is signs of pericarditis, pleurisy and pneumonitis. Initially, pains appear in the chest area, after a patient fever, the temperature rises to 38-40 degrees Celsius. Then signs of hydropericarditis and hydrothorax are added. An exacerbation can last from three days to three weeks.

Chest pains are accompanied by temperatures up to 38-40 degrees Celsius

The nature of complaints depends on which organ shell is involved in the pathological process (heart or lung). Moreover, there is a defeat of both one and both organs at once. Pericarditis is always present.

Symptoms can be divided into a triad:

  • long, mild pains in the region of the heart, are not relieved by traditional medicines, the duration of pain can reach several days, removal is possible only with the use of special therapy;
  • noise of pericardial friction;
  • elevated temperature (about 38 degrees) lasts for several days;
  • a slight accumulation of fluid is observed in the pericardial cavity, which does not affect the functioning of the heart organ, the defect is eliminated after treatment.
  • chest pain intensifies when breathing, note that with the accumulation of fluid in the pleural cavity, the intensity of pain decreases or is completely smoothed out;
  • elevated temperature;
  • shortness of breath intensifies (if not only the membrane is involved in the process, but also the lung itself), does not pass after taking diuretics and nitroglycerin;
  • limited movement of the lung from the side of the lesion;
  • antibiotic therapy is not effective.
  • cough, moist rales in the lungs;
  • temperature within 38 degrees Celsius;
  • general malaise, weakness;
  • antibiotic therapy does not help.

Coughing and wheezing in the lungs are some of the symptoms of pericarditis.

In addition, there is an isolated lesion of the sterno-costal joints. When the synovial membranes of the joints are involved in the pathological process, the so-called “shoulder syndrome” appears. Pain in the area of ​​the shoulder-shoulder joints on the left side, the movement of the joints is limited.

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Autoimmune post-infarction syndrome is very rare, but is accompanied by eczema, erythema, urticaria, dermatitis, vasculitis, glomerulonephritis. In this form, the pathology is prone to relapse.

09b8711209b552c293718aee7a046d20 - Dressler - s syndrome - what is it, symptoms, treatment and prevention

Based on the characteristic symptoms, the following forms of pathology of Dressler syndrome were identified:

  • typical form: variations on the theme of the classical triad;
  • atypical form: involvement of joints and skin;
  • malosymptomatic form: temperature, changes in blood composition, arthralgia.

It is important to conduct a comprehensive qualitative diagnosis of the patient’s condition. For this, hardware, laboratory and differential techniques are used.

An anamnesis is also collected and a physical examination is performed (listening to noise). The diagnosis depends on the results of the echocardiogram, electrocardiogram, radiographs.

Sometimes CT and MRI are necessary for the accuracy of the diagnosis.

Given the nature of the disease – after all, post-infarction syndrome appears as a result of an immune reaction to the inflammatory process – it is more effective to act with anti-inflammatory drugs. Unfortunately, traditional antibiotic therapy will not have the desired effect.

Post-therapeutic prophylaxis has not yet been developed. But patients with diseases of the organs of the cardiovascular system can take the following precautions:

  • reducing the impact of risk factors;
  • early response to myocardial infarction;
  • anti-relapse therapy.

Patients who have had myocardial infarction should be observed by a cardiologist.

Dressler syndrome is diagnosed today less and less. This is due to the development of innovative effective methods for the treatment and prevention of myocardial infarction. And after thrombolytic therapy, this syndrome does not form at all.

Therefore, patients who have undergone myocardial infarction should be observed by a cardiologist. And if there are atypical pains in the left side of the chest, fever, the general condition worsened – do not hesitate to examine.

Early detection of the pathological process and targeted treatment will help to avoid more serious complications.

Home heart attack

Dressler’s Syndrome (DM) is one of the complications of myocardial infarction, which is manifested by inflammation of the pericardium, pulmonary pleura, lungs, joints, fever, and markers of the inflammatory process, another name is postinfarction syndrome.

Consider the mechanism of the development of post-infarction syndrome, its causes, symptoms, methods of diagnosis, treatment, prevention, possible complications, prognosis.

Development mechanism

The body produces antibodies whose purpose is to bind circulating antigens. The resulting complexes settle on the surface of various organs.

Treatment of angina pectoris should be carried out necessarily, since this complication has an unfavorable prognosis. Its presence increases the risk of recurrent myocardial infarction and sudden cardiac death. Treatment can be medical and surgical.

  1. Drug treatment includes the appointment of the following groups of drugs:
    • Painkillers
    • Blood clots
    • Reducing myocardial oxygen demand
  2. Surgical treatment involves restoring vascular patency that causes a patient to experience angina attacks. The operation can be performed in 2 ways:
    • Stenting – installation of a stent in a vessel with the expansion of its lumen
    • Bypass surgery – creating a workaround for blood flow by applying an additional vessel to the vessels of the heart.

Dressler’s syndrome is a rare autoimmune disease that occurs against the background of a previous myocardial infarction. The first symptoms of pathology develop only a few weeks or months after the formation of ischemic changes in the muscle tissue of the heart.

Clinical signs are associated with the occurrence of pericarditis, inflammation of the serous membranes of the chest cavity and lungs. Manifestations include shortness of breath, general weakness, coughing, and pain. Treatment is based on the use of hormonal drugs that suppress the immune response.

Prevention involves preventing the development of myocardial infarction, which is the main etiological factor of the disease.

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. Doctors associate this pattern with significant progress in the medical field.

An important role in this is played not only by the treatment of Dressler’s syndrome itself, but also by the assistance provided to patients with acute cardiac ischemia.

6 Reasons for the development of angina pectoris

Early post-infarction angina can develop for the following reasons:

  1. Multiple damage to the blood vessels of the heart, which is not associated with a heart attack. This means that in addition to the clogged arteries that led to myocardial infarction, other vessels that feed the heart are affected. However, the manifestation of this lesion was not a heart attack, but bouts of pain of the type of angina pectoris.
  2. Incomplete dissolution of a blood clot in “infarction-bound” vessels. For this reason, the heart muscle continues to lack oxygen. In these areas, myocardial ischemia occurs, which is clinically manifested by angina pectoris.
  3. Restructuring of the left ventricle, which occurred in connection with the defeat of its wall on the background of myocardial infarction.

Prevention

Prevention of the disease is primarily aimed at preventing the development of repeated myocardial infarction. Its main areas are:

  • To give up smoking
  • Mobile lifestyle – walking at a moderate pace, not causing angina attacks
  • Rational nutrition with the exception of fatty, fried, sweet. Eating vegetables, fruits and fiber-rich foods.
  • Taking medications prescribed by your doctor, even if you feel well

It is proved that the use of NSAIDs, glucocorticoids during the acute, subacute phase of a heart attack is ineffective. A COPPS study (Colchicine for the Prevention of Post-pericardiotomy Syndrome) is currently being conducted, studying the feasibility of using colchicine as a prophylactic (3).

7 Clinical manifestations

Early post-infarction angina resembles ordinary angina pectoris, however, there are some of its distinctive features. The main clinical symptom of the disease is pain. Moreover, it has the following features:

  • The duration of pain is usually not more than 10-15 minutes
  • Occurs at rest or with little physical exertion
  • It extends to the left parts of the chest, neck, lower jaw, left clavicle, scapula, shoulder. Although it can spread to the right half of the chest.
  • The pains are intense, stitching, pressing, aching in nature
  • Poorly eliminated by taking nitroglycerin
  • May be accompanied by increased heart rate, nausea, vomiting, anxiety, increased blood pressure.

In some cases, pain may be absent. This happens in the case of the development of the so-called “silent myocardial ischemia.”

Dressler’s syndrome: what are it, causes, symptoms, complications and treatment

ComplicationDefinition
Heart tamponadeSqueezing the heart with fluid injected between the leaves of the pericardium.
Hemorrhagic pericarditisThe accumulation of blood inside the heart bag. It leads to compression of the heart.
Constrictive pericarditisInflammation of the pericardium, accompanied by a thickening of its leaves, narrowing of the lumen of the pericardial cavity. It leads to compression of the heart.
Adhesive PericarditisThe formation of screeds, adhesions between the wall of the heart and the leaves of the pericardium. It is dangerous to develop a “shell-shaped heart” – a pathology in which the heart appears inside an inelastic pericardium, cannot fully contract, relax.
Occlusion of the coronary shuntDeterioration of patency of the coronary shunt.
AnemiaReduced hemoglobin and/or red blood cells.
glomerulonephritisInflammation of the renal glomeruli.
Aseptic Acute HepatitisAcute inflammation of the liver.

Currently, when using thrombolytic drugs and antiplatelet agents, thromboembolic complications occur in 2-6% of patients with myocardial infarction.

In the mechanisms of their occurrence, an increase in the blood coagulation activity and the development of DIC syndrome are of great importance; changes in the vascular wall due to atherosclerosis; blood stasis due to shock and heart failure; violation of cardiac hemodynamics in connection with the formation of aneurysm, myocardial dilatation, atrial fibrillation; thromboendocarditis; exacerbation of thrombophlebitis of the pelvis, lower legs. In the development of these complications, long-term immobility of the patient is of great importance.

Pulmonary thromboembolism is most commonly observed. Diagnosing it is complicated. This is due to the low specificity of the symptoms, the difficulty of distinguishing it from the manifestations of myocardial infarction. In patients with pulmonary embolism, ECG dynamics resembling posterior myocardial infarction are observed: Q III (SI-Q III), negative T in III, aVF, V1-V4, high P in II, III leads. The differences are: high R in lead III, increased “pulmonary” fraction of LDH3. The diagnosis is confirmed by the dynamics of x-ray changes in the lungs.

Thromboembolism of the extremities leads to sudden severe pain, its cooling, the disappearance of the pulse, the appearance of paresthesia, the disappearance of sensitivity, paresis.

Renal artery thromboembolism is characterized by varying severity of pain in the lower back, weakness, nausea, vomiting, increased blood pressure, and the appearance of red blood cells in the urine. There may be oliguria, symptoms of renal failure.

Mesenteric artery thromboembolism is manifested by severe, vague abdominal pain. Then intestinal paresis develops and the clinic of dynamic obstruction. Can be tarry stools. Shock often develops.

Thromboembolism of cerebral vessels. The clinical picture is characterized by sudden headache, the development of focal symptoms. There may be varying severity of cerebral symptoms.

With all thromboembolic complications, acute left ventricular failure may occur.

Literature

f5945e7133343ee91a798ec275abc702 - Dressler - s syndrome - what is it, symptoms, treatment and prevention

Higher medical education. Kirov State Medical Academy (KSMA). The local therapist.

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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