Dressler syndrome (post-myocardial-infarction pericarditis)

What it is

Post myocardial infarction syndrome, or Dressler syndrome, is pericarditis occurring after an MI without an infective cause. It is a late complication of STEMI, standing beside arrhythmias, pump dysfunction and heart failure, the mechanical complications and left ventricular thrombus, and it is one of the cardiovascular causes of acute pericarditis alongside acute MI itself and aortic dissection.

It is thought to be due to circulating antibodies against cardiac muscle cells, an autoimmune etiology, with immune complex deposition and then inflammation. That is why it is late rather than immediate, and why it has no infective cause to find.

The time after the MI is reported as 1-2 weeks in one source and 2-10 weeks in another.

How it presents

The picture is that of acute pericarditis: pleuritic chest pain, dry cough and a friction rub. The pericardial rub is the pathognomonic sign.

The pain of acute pericarditis is burning, aching, dull or pleuritic, changes with movement, is worse on lying flat and improves on leaning forward. SOB, palpitations and intermittent low-grade fever go with it, along with tachypnoea.