Dressler’s syndrome in cardiology is pericarditis of an autoimmune nature of origin, which develops several weeks after acute myocardial infarction. This complication is characterized by the traditional triad of symptoms: chest pain, pulmonary manifestations (cough, wheezing, shortness of breath), noise of friction between the leaves of the pericardium.
Dressler's syndrome in cardiology (or post-infarction syndrome) refers to autoimmune damage to the tissues of the pericardial sac. This is a complication that is caused by an inadequate immune response to destructive changes in myocardial proteins. This pathological process was described by a cardiologist from the USA V. Dressler in 1955. In his honor, the disease received its second name. In addition, in the medical literature you can find such terms as: post-infarction polyserositis, late pericarditis, post-traumatic, post-cardiotomy and pericardial syndrome. In general, the prevalence of this heart attack complication is 3-4%. However, according to information obtained from various sources, taking into account the low-symptom and atypical forms, this complication develops in approximately 15-30% of patients who have had repeated, complicated or extensive myocardial infarction.
Causes
The initial cause of Dressler syndrome in cardiology is ischemic damage to the structural fibers of the heart muscle, which leads to the death of cardiomyocytes. In most cases, it develops with complicated large focal infarction. During the destruction of necrotic tissue, denatured proteins begin to enter the bloodstream. The immune system, in turn, responds to them as alien. As a result, an autoimmune reaction occurs, which is the cause of the development of post-infarction syndrome.
Blood antigens, which penetrate the pericardial membrane in the process of impaired myocardial integrity, have a certain value in the formation of the symptom complex of this complication of a heart attack. Therefore, in addition to the acute stage, hemopericardium, characterized by hemorrhage in the pericardial cavity, can act as the trigger for the formation of the disease. In addition, this condition may be due to chest injuries, heart wounds, or inadequate heart surgery. Also at risk are post-infarction patients who have autoimmune pathologies. Some doctors believe that the cause of the development of the inflammatory process is a viral infection. However, cardiologists have no definite answer on this issue yet.
Pathogenesis
Dressler’s syndrome in cardiology is an autoimmune process that develops as a result of intensified production of antibodies to cardiac antigens. In this case, an acute violation of the processes of blood flow into the myocardium and the death of its cells entails the resorption of necrosis zones and the release of denatured components into the bloodstream. This contributes to the development of an immune response with the formation of autoantibodies, whose action is directed against proteins present in the serous integument of target organs.
Immune antibodies to cardiomyocytes, which are present in large quantities in the plasma of post-infarction patients, form immune complexes containing cells of their own tissues. They circulate freely in the bloodstream, accumulate in the visceral, pericardial pleura and in the internal structures of the articular bags, provoking an aseptic inflammatory process. In addition to this, the level of cytotoxic lymphocytes, which destroy damaged body cells, begins to increase. Thus, the state of both humoral and cellular immunity is significantly disrupted, which confirms the autoimmune nature of the symptom complex.
Varieties
Dressler's syndrome after myocardial infarction - what is it? This ailment is divided into 3 forms. Within each of them there are also several subspecies, the classification of which is based on the localization of inflammation. So, Dressler's syndrome happens:
1. Typical. Clinical manifestations of this form are associated with inflammation of the visceral pleura, pericardium and lung tissue. It includes combined and single variants of autoimmune damage to connective tissues:
- pericardial - the parietal and visceral sheets of the pericardial sac are inflamed;
- pneumonic - infiltrative disorders in the lungs are formed, leading to pneumonitis;
- pleural - pleura becomes the target of antibodies, signs of hydrothorax develop;
- pericardial-pleural - there are symptoms of sensitization of the pleura and serous membrane of the pericardium;
- pericardial-pneumonic - the pericardial membrane and lung tissue are affected;
- pleural-pericardial-pneumonic - from a heart bag, inflammation passes to the pulmonary and pleural structures.
2. Atypical. For this form, variants are characteristic due to the defeat of the joints and vascular tissues by antibodies. It is accompanied by an inflammatory process in large articular joints or skin reactions: pectalgia, "shoulder syndrome", erythema nodosum, dermatitis.
3. Unsymptomatic (obliterated). In this form with mild symptoms, a fever, persistent arthralgia and a change in the composition of white blood are noted.
When diagnosing atypical and erased forms of the syndrome, some difficulties often arise that determine the relevance of the most in-depth study of this disease.
Symptoms
The classic Dressler syndrome is formed approximately 2-4 weeks after a heart attack. The most common symptoms include severity and pain in the chest, fever, cough, shortness of breath. The pathological process in most cases begins acutely, with an increase in temperature to febrile or subfebrile marks. Dizziness, weakness, nausea appear, breathing and pulse become more frequent.
A mandatory element of the symptom complex is pericarditis. Painful sensations in the area of the heart that are different in intensity are typical for it, giving off to the abdomen, neck, shoulders, shoulder blades and both hands. The pain can be sharp, paroxysmal, or dull, compressive. When swallowing and coughing, chest tightness is noted, the pain intensifies. When lying on your stomach or standing, it weakens. Often there are palpitations, shortness of breath, frequent shallow breathing. 85% of patients have a friction noise of pericardial leaves. After a few days, the pain subsides. A characteristic manifestation of pleurisy is a one-sided stitching pain in the upper region of the body, which intensifies with a deep breath and tilt to the healthy side.
For pneumonitis, typically severe weakened breathing, wheezing, shortness of breath, cough. Less commonly, lobar pneumonia develops. The disease is accompanied by weakness, excessive sweating and febrile syndrome. Blood impurities may appear in sputum. With atypical forms of the disease, joint functions are impaired.
Pericarditis and Dressler Syndrome
Pericarditis is an inflammation of the pericardial sac of a rheumatic, infectious or post-infarction character. Pathology is manifested by weakness, pain behind the sternum, which intensifies with inspiration and cough. For the treatment of pericarditis, bed rest is necessary. In the case of a chronic form of the disease, the regimen is determined by the condition of the patient. In acute fibrinous pericarditis, symptomatic treatment is prescribed: anti-inflammatory non-steroid drugs, analgesics to eliminate the pain syndrome, medications that normalize the metabolic processes in the heart muscle, and more. With Dressler's syndrome, treatment of pericarditis is carried out with drugs that eliminate the underlying disease.
Abdominal localization of the syndrome
The pathology of peritonitis, the inflammatory process in the internal lining of the cavity, is determined. It features a vivid clinical picture:
- intense, excruciating abdominal pain. The strength of painful sensations decreases when finding a comfortable body position - most often lying on one side with bent legs;
- stool disorders;
- marked increase in temperature.
With the development of this form of the syndrome, it is urgent to differentiate the autoimmune form from the infectious form, which often acts as a consequence of digestive tract pathologies. The tactics of treatment, which most often implies the use of various groups of medicines, depend on the results of timely diagnosis.
Pathology diagnostics
We continue to describe Dressler's syndrome after myocardial infarction. What is it is now clear. However, the situation is described only in the general case, it is better for each specific person to consult with the attending physician. When diagnosing this complication of a heart attack, patient complaints, characteristic clinical symptoms and the results of a comprehensive instrumental and laboratory examination are taken into account. Valuable diagnostic parameters that give a complete picture of the patient's condition include:
- Clinical criteria. Symptoms that confirm the high likelihood of the development of Dressler polyserositis are febrile fever and pericarditis.
- Laboratory research. In the KLA are possible: eosinophilia, leukocytosis, increased ESR. In addition, a blood test is performed on markers of damage to the heart muscle. An increase in the level of globular proteins - troponin T and troponin I - and confirms the fact of cell death.
- In the diagnosis of Dressler syndrome, an ECG is often used, on which negative dynamics are noted. The most typical symptom is unidirectional movement of the ST segment in several leads.
- Ultrasound of the pericardium and pleural cavities.
- Chest x-ray. With the development of pleurisy, the interlobar pleura thickens, with pericarditis, the heart shadow expands, with pneumonitis, blackouts in the lungs are determined. In some cases, cardiomegaly is clearly visible in Dressler's syndrome after a heart attack.
- In unclear diagnostic situations, MRI of the lungs and heart is prescribed.
Treatment of this disease
Treatment takes place in an inpatient setting. Emergency care for Dressler's syndrome, as a rule, is not required, since there is no obvious threat to life. However, if treatment is started sooner, the chances of recovery are significantly increased.
The main role in the spectrum of therapeutic measures for Dressler’s post-infarction syndrome is played by drug therapy, which has several goals and involves the use of multidirectional drugs:
- Cardiotropic, which help eliminate heart disorders. These are the medicines used in the treatment of coronary heart disease: beta-blockers, antianginal drugs, nitrates, calcium channel blockers, cardiac glycosides.
- Anti-inflammatory. In the case of resistance to NSAIDs, short courses of glucocorticoid administration are given. In severe forms of the disease, medicines of other groups are used (Methotrexate, Colchicine).
Anticoagulants due to the increased likelihood of developing hemopericardium during treatment after a heart attack are not used. If necessary, their use is prescribed subtherapeutic dosage. In each individual case, the treatment of this pathology is selected individually. With severe pain, intramuscular administration of analgesics is indicated. With a significant accumulation of effusion, a pericardial cavity puncture or pleurocentesis is performed. With cardiac tamponade, surgery is performed - pericardectomy.
How to prevent the development of Dressler syndrome?
Such a syndrome is not considered a life-threatening condition, even with the most severe course, the prognosis for the patient is relatively favorable. Primary prevention methods, which are aimed at eliminating the causes of Dressler's syndrome, have not yet been developed. However, early activation is recommended to reduce the likelihood of articular manifestations in patients after an acute heart attack. In pathologies with a relapsing course, anti-relapse therapy is prescribed to prevent a repeated exacerbation of the pathological process.
Clinical guidelines for Dressler syndrome
In order to reduce the risk of developing this disease, it is necessary to carefully consider all the emerging symptoms associated with heart disease. Since the initial cause of the development of Dressler’s syndrome is myocardial infarction, preventive measures should first of all be aimed at preventing the development of this acute condition. The main clinical recommendation is timely monitoring by a cardiologist, taking anti-ischemic, anti-thrombotic drugs, as well as drugs to lower high cholesterol.
Complications of this pathology
In the absence of a high-quality and timely diagnosis and medical assistance, Dressler's syndrome can lead to the development of constructive or hemorrhagic pericarditis (the appearance of bloody exudate or compression of the heart tissue), and in more advanced cases, it causes serious cardiac tamponade. This pathology is characterized by a relapsing course with remissions and exacerbations that occur at intervals of 1-2 weeks to 2 months. Under the influence of therapy, a weakening of symptoms is observed, and in the absence of correction, the disease, as a rule, attacks with renewed vigor.