Dressler’s syndrome
Overview
Dressler’s syndrome is a delayed, immune‑mediated pericarditis that most commonly follows myocardial infarction or cardiac surgery. It classically presents 2-10 weeks after the index event with sharp pleuritic chest pain, low‑grade fever and varying degrees of pericardial effusion.
Most cases are non‑infectious and respond to anti‑inflammatory therapy, but complications (large effusion, tamponade, recurrence, rarely constriction) require urgent specialist management (see NICE CG95; GOV.UK clinical codebook).
Pathophysiology and aetiology
- Caused by an autoimmune reaction to cardiac antigens exposed by myocardial necrosis or surgical manipulation.
- More likely after transmural infarction and after cardiac procedures.
- Incidence has declined with early reperfusion and modern medical therapy.
- Produces pericardial inflammation and sometimes pericardial effusion.
Typical timing
- Classically 2-10 weeks after myocardial infarction or cardiac surgery.
- Differentiate from early (peri‑infarction) pericarditis, which occurs within days of MI and has a different mechanism (direct epicardial inflammation).
Clinical features
- Pain: sharp, pleuritic chest pain that is worse when lying flat and relieved by sitting/leaning forwards; may be mistaken for recurrent ischaemia.