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Dressler's syndrome. post MI syndrome, postcardiac injury syndrome (PCIS)

Etiology: - uncommon late complication of myocardial infarction (MI). Epidemiology: - 3% of patients after MI Pathology: - inflammatory response - immune-complex deposition in the pericardium & lung pleura Clinical manifestations: 1) onset of symptoms 2-10 weeks post MI 2) pericarditis, pericardial rub, pericardial effusion 4) pleuritis, pleural effusion 5) chest pain - generally arises from inflammation of parietal pleura - generally sharp, pleuritic, worsened with inspiration - positional, relieved by sitting up, leaning forward 6) fever, malaise 7) course of disease may be long 8) frequent exacerbations & remissions Laboratory: 1) complete blood count (CBC): leukocytosis 2) elevated erythrocyte sedimentation rate (ESR) 3) anti myocardial antibodies 4) pleural fluid analysis a) may show RBC, lymphocytes, reactive mesothelial cells b) protein < that of serum c) normal glucose d) gram stain negative for bacteria Special laboratory: 1) electrocardiogram: - diffuse ST segment elevation (may be marked) or diffuse PR-segment depression [3] 2) echocardiogram: pericardial effusion 3) thoracentesis Radiology: - chest X-ray: pleural effusion Management: 1) symptomatic treatment 2) colchicine + full dose aspirin - avoid non-aspirin nonsteroidal antiinflammatory drugs & glucocorticoids because they impede myocardial healing [3]* 3) prednisone or other glucocorticoid a) severe pain refractory to aspirin & colchicine or contraindications to aspirin & colchicine b) prednisone 1 mg/kg QD with taper 4) discontinue anticoagulation if possible to avoid hemorrhagic pericarditis * ref [3] describes case of Dressler's syndrome after MI with placement of drug-eluting stent. Clopidogrel is not mentioned in the case discussion, nor the risk of hemorrhage with full- dose aspirin + clopidogrel

Related

pericarditis

General

complications of myocardial infarction hemodynamic instability (compromise) syndrome

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 112
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015
  3. NEJM Knowledge+ Question of the Week. Aug 23, 2016 http://knowledgeplus.nejm.org/question-of-week/32/