Dressler’s syndrome is a rare but treatable type of inflammation in the sac surrounding the heart. It develops shortly after a heart injury, such as a heart attack, and may return after treatment.

The pericardium is the layer of tissue surrounding the heart, supporting its stability, function, and beating movements. A type of inflammation known as pericarditis may occur in the pericardium following an injury, surgery, or infection that affects the heart.

Pericarditis might develop for many reasons, including viruses or cancers. Sometimes, it may not be clear why the condition occurs. However, Dressler’s syndrome is an extremely rare type of pericarditis that usually develops after a heart injury. It might occur due to immune activity that causes inflammation after a heart injury by responding excessively.

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Dressler’s syndrome is a type of secondary pericarditis. The term secondary means that it occurs due to another health problem — in this case, injury to the heart. It may occur with or without fluids building up in the space between the layers of the pericardium or the pericardium and the heart muscle, also called pericardial effusion.

Other names for Dressler’s syndrome include:

  • post-myocardial infarction syndrome
  • post-traumatic pericarditis
  • post-cardiac injury syndrome
  • post-pericardiotomy syndrome

When physician William Dressler first described the condition in 1956, he suggested that 3% to 4% of people who had a heart attack might develop Dressler’s syndrome.

However, recent research suggests that modern treatments have almost eliminated the condition. However, this may be due to people underreporting and not reporting occurrences that do not cause symptoms.

The direct cause of Dressler’s syndrome is unclear. According to the Autoimmune Association, damaged heart tissue releases proteins that may signal to the immune system that repair is necessary in the area. This immune response might lead to inflammation in the pericardium.

Underlying risk factors for developing Dressler’s syndrome after heart surgery or injury include:

  • viral infections, especially by Coxsackie B, adenovirus, and cytomegalovirus
  • a history of heart surgery that causes damage to tissue, such as aortic valve replacement
  • having heart problems at a younger age
  • a history of pericarditis
  • having taken prednisone, a steroid medication, to treat pericarditis
  • having B negative blood type
  • using halothane anesthesia during a surgical procedure

Dressler’s syndrome may cause the following symptoms:

  • weakness and tiredness
  • fever
  • chest pain that can worsen when inhaling and improves when leaning forward
  • irritable mood
  • low appetite
  • breathing problems
  • joint pain

These symptoms may develop between 3 to 4 days and 2 to 6 weeks after a heart injury, with some occurring several months later. Dressler’s syndrome can be recurrent, meaning that symptoms may relapse or come back following treatment up to 1 year after the original injury.

If a person feels these symptoms for more than 2 weeks after a heart attack or heart procedure, they need to speak with a doctor.

No firm set of diagnostic criteria are available for Dressler’s syndrome. However, a doctor will listen to the heart and lungs using a stethoscope. They may be able to hear layers of the pericardium rubbing against each other, known as friction rub.

They may also check for pericardial effusion using a chest X-ray or MRI scan. Pleural effusion, or fluid buildup in the pleural sac — the outer layer of the lung — might also be a diagnostic feature of Dressler’s syndrome.

A doctor might request blood tests to check levels of inflammatory proteins or white blood cells in the blood. They may also request an echocardiogram to check for atypical heart function.

While Dressler’s syndrome is rare, it can lead to severe complications. These might include cardiac tamponade and constrictive pericarditis.

Cardiac tamponade occurs when too much fluid builds up in the pericardial sac, placing excessive pressure on the heart. Cardiac tamponade reduces the heart’s ability to pump blood effectively, as it has to work harder.

Constrictive pericarditis is the thickening and scarring of the pericardium after repeated or ongoing inflammation. The condition also reduces the heart’s ability to pump blood.

To help with a further evaluation, a doctor will likely check for Dressler’s syndrome in any individuals who present with fatigue 2 weeks after a heart attack. Tamponade is an emergency that needs quick treatment.

People with Dressler’s syndrome only need to stay in the hospital if complications affect how the heart works. Most of those with these syndromes can take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or aspirin, for 4 to 6 weeks while the fluid buildup reduces.

If symptoms do not respond to NSAIDs, a doctor may prescribe a course of corticosteroids, such as prednisone, across around 4 weeks.

More severe Dressler’s syndrome that leads to pericardial effusion and cardiac tamponade may require a procedure called pericardiocentesis. This involves extracting the fluid with a large needle under anesthesia.

If symptoms return, especially in children, a person may receive intravenous immunoglobulin therapy via the veins. This may reduce the immune reaction to the initial heart injury and could be effective in people who do not respond to other treatments.

Dressler’s syndrome is a rare type of pericarditis. It develops shortly after a heart injury or surgery. Symptoms include chest pain, breathing issues, fever, and fatigue.

Doctors can diagnose Dressler’s syndrome using echocardiography scans, other imaging scans, and blood tests. Treatment often involves nonsteroidal or steroidal anti-inflammatory medications. However, if complications such as cardiac tamponade or constrictive pericarditis develop, the doctor might consider pericardiocentesis.