Dressler Syndrome: Causes, Symptoms & Treatment

Dressler syndrome is the name given to a particular form of pericarditis that is not due to pathogens but to a type of late reaction of the immune system to destroyed heart muscle tissue. The triggering factor can be a heart attack, a heart muscle injury or heart surgery. Typical inflammatory reactions such as fever and leukocytosis usually develop, and pericardial or pleural effusion is common.

What is Dressler syndrome?

Dressler syndrome is the name given to an atypical inflammation of the heart muscle (myocarditis) that is accompanied by typical symptoms of inflammation, but without any detectable pathogens involved in the inflammation. In this case, the immune system has not reacted to pathogenic germs, but in a kind of autoimmune reaction to dead myocardial tissue. This is myocardial tissue that has been necrotized due to a heart attack, injury, or because of surgery. The typical inflammatory reactions that can then appear with a time delay of a few days to several weeks, in some cases even up to two months, are comparable to those that occur after a typical bacterial infection. In both cases, it is the immune system that causes the symptoms. Cases are also observed in which there are repeated chest pains similar to those of angina, “faking” another myocardial infarction.

Causes

Dressler syndrome is always associated with necrotized myocardial tissue, but the processes that cause such a late immune response are not (yet) fully understood. It is considered extremely likely that immune complexes are formed in the dead tissue. Immune complexes consist of an antigen and antibodies in the form of immunoglobulins that can bind to the antibodies. In this case, the antigen consists of partially degraded myocardial cells, i.e. the body’s own cell substance, which is marked by the immune system and “released” for further degradation. Dressler syndrome is therefore an autoimmune-like reaction. The prerequisite for the development of the disease is always destroyed myocardial cells such as those resulting from a heart attack, from injuries, or from surgical interventions on the heart or heart valves.

Symptoms, complaints, and signs

Dressler syndrome can accompany a variety of specific and nonspecific symptoms such as general signs of inflammation. Fever is common as observed in many “true” infectious diseases, but other signs suggestive of inflammation can also be observed. Typical is the occurrence of pericarditis, an inflammation of the pericardial sac with frequently observed fluid influx. In many cases, pleurisy (inflammation of the pleura) and pneumonia (inflammation of the lungs) also present. Pleurisy or pneumonia may present as a visible sign in bloody sputum. Pneumonia is also often accompanied by an accumulation of fluid, a pleural effusion. As a rule, typical inflammatory reactions can also be determined by laboratory chemistry. In most cases, leukocytosis is seen with a marked increase in leukocytes, indicating an acute inflammatory situation. Likewise, there is an increase in C-reactive plasma protein (CRP), which can always be interpreted as an indication of acute inflammation. Dressler syndrome may also be accompanied by chest pain resembling that of a myocardial infarction without, for example, any abnormal ECG findings.

Diagnosis and Course

Because of the sometimes nonspecific symptoms of the disease, a perfect diagnosis of Dressler syndrome is not always easy to make. The timing of the onset of symptoms is important. These typically appear two weeks to a maximum of three months after a myocardial infarction or cardiac surgery. Other symptoms such as fever, general feeling of illness, and evidence of pericardial effusion should also be present. Laboratory chemistry should also show evidence of leukocytosis and an elevated CRP. To confirm the diagnosis, other causes of the symptoms should be differential diagnosed and excluded. The disease can lead to a chronic course if left untreated, with a variable prognosis. In principle, Dressler’s syndrome is treatable with medication and has a good prognosis.However, recurrent occurrence after healing is not excluded.

Complications

Dressler syndrome usually results in disease and complications of the heart. If the syndrome is not treated, death may occur in the worst case. The patient suffers from a severe fever in Dressler’s syndrome and is limited in his daily life as a result. Often, this also results in inflammation of the pericardium. This can also develop into pneumonia, in which case hemoptysis occurs. It is not uncommon for patients with hemoptysis to also suffer from panic attacks. The affected person also suffers from chest pain, which is similar to the pain of a heart attack. Dressler’s syndrome, however, can be treated relatively well, so that no further complications arise from it. Various medications are used for this purpose, and antibiotics do not have any effect. In severe cases, circulatory shock can also occur. This is also associated with very low blood pressure and a rapid pulse. If this acute condition is not treated, death will result. Therefore, medical intervention is necessary in this case. Life expectancy is not reduced with timely treatment. Complications can arise if Dressler’s syndrome is caused by an infarction, resulting in paralysis and limitations in daily life.

When should you see a doctor?

Because Dressler syndrome does not heal itself, a doctor must be consulted in any case. However, the symptoms themselves may be nonspecific, so the condition is not always recognized immediately. As a rule, the doctor should be consulted if there is a fever or a strong cough after an operation. Bloody sputum can also occur and is also an indication of Dressler’s syndrome. Furthermore, most sufferers also develop inflammation in the lungs or pleura, so medical treatment is necessary. In many cases, Dressler’s syndrome still occurs when the affected person is in the hospital, so that treatment with antibiotics can also be initiated directly. If the affected person is no longer in a hospital, a general practitioner or even the hospital directly can be consulted. Usually, with timely diagnosis and treatment, there is a positive course of the disease without complications.

Treatment and therapy

Since Dressler’s syndrome is not any kind of infection and not a bacterial infection at all, no antibiotic can be effective. The condition is usually well treatable with medication. Choices include ASA (acetylsalicylic acid), known to us all as the main active ingredient in aspirin, or other non-steroidal-based anti-inflammatory and antipyretic anti-inflammatory drugs such as ibuprofen, diclofenac, and many others. In persistent cases, glucocorticoids, steroid hormones such as cortisone or prednisolone, may also be used. In severe courses of Dressler’s syndrome, life-threatening pericardial tamponade may be imminent. This is a serious complication that can result from pericardial effusion. It results in a decreased degree of filling of the heart with blood. Pericardial tamponade is accompanied by a rapid pulse and a barely measurable low blood pressure. Almost all the symptoms of an immediately life-threatening circulatory shock are thus fulfilled. Pericardiocentesis followed by pericardial drainage may be necessary to resolve the life-threatening condition.

Outlook and prognosis

Dressler syndrome leads to very serious symptoms and complications. It must therefore be treated in all cases, otherwise the affected person will die. Self-cure does not occur with this syndrome. If Dressler’s syndrome is not treated, the patient will suffer from a high fever and further from pericarditis. This is associated with severe pain, and those affected also appear tired and fatigued. Inflammation of the lungs can also occur, which is associated with breathing difficulties. In most cases, the life expectancy of the patient is drastically reduced if Dressler syndrome is not treated. Early treatment always has a positive effect on the further course of the disease and can prevent serious complications. The treatment itself is carried out by taking medication and alleviates the symptoms.However, surgical intervention is also often necessary to completely limit the symptoms. In this case, there are usually no particular complications. However, even with successful treatment, the life expectancy of the affected person is limited. The further course also depends strongly on the exact cause of the syndrome.

Prevention

Direct preventive measures that could effectively prevent the occurrence of Dressler syndrome do not exist. What is recommended is some attention to initial symptoms and signs after events such as myocardial infarction, cardiac surgery, or cardiac injury, which usually precede Dressler syndrome. However, the occurrence of the disease after the aforementioned events is not obsessive but occurs in only a small percentage of affected individuals, so preventive medication use after myocardial infarction or cardiac surgery is not recommended.

Follow-up

In Dressler syndrome, very few aftercare measures are available to the patient in most cases. First and foremost, early and rapid treatment of the disease must be performed to prevent further complications and to avoid reducing the life expectancy of the affected individual. In the worst case, Dressler’s syndrome can lead to the death of the affected person if the heart muscle becomes inflamed. The treatment itself is carried out with the help of medication. Although there are no particular complications or other discomforts, the affected person should always make sure that the medication is taken correctly and as prescribed by the doctor. It should also be noted that lubricants should not be taken over a long period of time. A healthy lifestyle with a healthy diet can also have a very positive effect on the further course of Dressler’s syndrome. If possible, the affected person should also refrain from taking alcohol or smoking. Strenuous or stressful activities should also be avoided in order not to put unnecessary strain on the heart. In many cases, support and care from one’s own family is also very useful, which can make the affected person’s everyday life easier.

What you can do yourself

Dressler syndrome has the appearance of an inflammation-typical course without evidence of pathogens. Behind it, however, is an inflammation of the heart muscle that should not be underestimated, which gradually develops due to dead heart muscle tissue, after an accident, heart surgery or a heart attack. A weakened immune system is considered a symptom trigger, as the body’s own defenses cannot properly reject the necrotic tissue. Thus, self-help can only be applied to a limited extent. The syndrome can be treated relatively quickly by consistently taking prescribed medications. However, the disease can take a chronic course as well as recurrent behavior. If the patient follows some rules, these can be easily applied and implemented in the context of self-help and after recovery. The focus is on a healthy lifestyle and the maintenance or stabilization and strengthening of the immune system. Sufficient exercise in the fresh air is recommended, consisting of walks in nature as well as gentle sports such as swimming, aqua training or Tai-Chi. Sauna sessions should only be undertaken with a doctor’s permission. Bad habits such as smoking, alcohol and drug use should be discontinued if only for the sake of general well-being. Eating habits should also be adjusted in the direction of a low-fat diet rich in vitamins and containing plenty of omega-3 fatty acids. This is especially true for those with diabetes mellitus and significant obesity.