Dressler's Syndrome

Dressler's syndrome is also known in medicine as a post-infarction syndrome. This condition is an autoimmune complication after the transfer of myocardial infarction. It develops, usually, after two to six weeks after the onset of an acute period of myocardial infarction.

[1], [2], [3], [4], [5]

Epidemiology

Previously, doctors believed that only 4% of patients suffer from Dressler's syndrome after myocardial infarction. But, if we take into account all the low-symptom and atypical forms, we can say that it develops in 23% of cases. Some experts even point to a higher prevalence rate of 30%. Over the past few years the frequency of postinfarction syndrome has decreased. This can be explained by the widespread use by patients of non-steroidal anti-inflammatory drugs and the reperfusion method of infarction therapy that help to reduce the level of myocardial damage.

One of the reasons for the reduction in the number of patients with this disease is the use of various modern drugs that are part of complex therapy (statins, aldosterone antagonists, inhibitors of certain enzymes).

[6], [7], [8], [9], [10], [11]

Causes of the syndrome Dressler

The most important reason that this syndrome develops is necrosis or damage to cells in the muscle fibers of the heart that occur in patients after a heart attack. The products of decay (myocardial and pericardial antigens) thus fall into the blood, the patient develops autosensitization to proteins from the destroyed cells, that is, autoimmune aggression develops.

Immune cells (cardiac reactive antibodies) that recognize foreign bodies, or, so-called antigens, because of identity in the structure, begin to attack proteins that are located in the membrane structures of their own organs (lungs, heart, joints). That is, the body considers its own cells to be alien and begins to fight them. Articular membranes become highly inflamed, but without the involvement of pathogenic bacteria or viruses (so-called aseptic inflammation). This causes quite strong pain.

Dressler's syndrome appears not only after transmural or large-focal heart attacks, but also after cardiac surgery. If a patient already has an autoimmune disorder, the risk of complications increases.

[12], [13], [14], [15], [16], [17]

Pathogenesis

In rare cases, this syndrome can develop after some traumatic lesions of the cardiac region (concussion, wounds, a strong blow to the chest area).

To date, specialists consider Dressler's syndrome as an autoimmune disease that is caused by pericardial and myocardial antigens and autosensibilization. Great importance is attached to the antigenic characteristics of the blood that has got into the pericardium. In patients with this syndrome, an elevated level of the C3d fraction is detected. This can lead to complement-mediated tissue damage.

Patients also experience some changes in cellular immunity. According to the latest data, with Dressler's syndrome, the level of T cells increases.

[18], [19], [20], [21], [22]

Symptoms of the syndrome Dressler

The first symptoms can appear from two weeks to one month after the episode of myocardial infarction. The main signs of this disease are:

1. The patient feels constant fatigue and weakness.
2. The patient rises body temperature (up to 39 degrees), which may decrease slightly between attacks.
3. A common symptom of Dressler's syndrome is pericardial. In the chest area there are pressing and sharp pains, which can intensify during inspiration or coughing. Painful sensations can radiate to the shoulder and neck.
4. Pains in the lungs (pneumonitis), which can be accompanied by a dry cough, shortness of breath, the appearance of blood during a cough.
5. Painful sensations mainly on the left side of the chest (pleurisy), which are accompanied by a dry cough.
6. Cardiovascular syndrome - numbness of the left arm, a feeling of "goose bumps" in the area of the brush, marble and pale skin.
7. Irritations on the skin - rashes, which outwardly resemble allergic.
8. The area of the clavicle and sternum on the left side swells and can hurt.

Dresser's early syndrome

It develops in the period up to two weeks from the onset of myocardial infarction and is characterized by the development of dry pericarditis, which in 70% of cases is asymptomatic.

Only a small percentage of patients (15%) after the first episode of myocardial infarction was stopped, there may be a dull and prolonged pain in the region of the heart, which has an increasing character.

[23], [24], [25], [26], [27], [28], [29]

Stages

There are several forms of Dressler's syndrome:

1. An expanded or typical form - usually characterized by such violations: pleurisy, pericardium, polyarthritis.
2. Atypical form - differs following symptoms: cardiovascular syndrome, asthmatoid and peritoneal syndrome, skin irritations, arthritis.
3. Malosymptomnaya or asymptomatic form - a change in blood composition, fever, arthralgia.

[30], [31], [32], [33], [34], [35]

Complications and consequences

Patients with postinfarction syndrome may develop kidney pathologies, including autoimmune glomerulonephritis. Vessels with development of hemorrhagic vasculitis can also be affected.

If you do not carry out treatment with hormonal drugs, then the pericardial effusion can go to the adhesive pericarditis. This can lead to the development of restrictive heart failure.

[36], [37], [38], [39], [40], [41], [42]

Diagnostics of the syndrome Dressler

A specialist cardiologist can make a diagnosis based on complaints received from patients with common symptoms that manifest themselves in the first two months after an episode of myocardial infarction. To confirm the diagnosis, a check is made - auscultation of the thorax area in order to listen to possible noise from friction of the pericardium with pleura. There may also appear wet wheezing in the lungs. To clarify the diagnosis, the following methods can also be used:

1. Conducting an extensive blood test.
2. Carrying out of immunological research, biochemical analysis of blood and rheumatological tests. With postinfarction syndrome, there will be an increase in the level of the C-reactive protein, the fraction of troponins and creatine phosphokinase.
3. Echocardiography - helps to identify thickening of the pericardium, fluid in the cavity and deterioration of its mobility.
4. X-rays of the thoracic region - you can diagnose pleurisy and pneumonitis.
5. In some cases, an MRI of the thoracic department is prescribed.

[43], [44]

Analyzes

When carrying out a blood test, the patient will experience the following changes:

1. Leukocytosis.
2. Often an increase in ESR.
3. Eosinophilia.
4. A sharp increase in the C-reactive protein.

Dressler's syndrome must be differentiated with the following diseases:

• Recurrent or repeated myocardial infarction;
• Pneumonia of infectious etiology;
• PE;
• pericarditis and pleurisy.

[45], [46], [47], [48]

Treatment of the syndrome Dressler

For the treatment of Dressler's syndrome, which originated for the first time, in-patient treatment is necessary. When relapses occur, you can treat outpatiently if the patient's condition is not severe.

Most often non-steroidal anti-inflammatory drugs are used. If the treatment with non-steroidal anti-inflammatory drugs has not yielded a positive result, the cardiologist can recommend the average doses of some hormonal drugs. Treatment with anticoagulants is not performed, but if there is a need for their appointment, low dosages are used.

Medications

Glucocorticosteroid hormones:

1. Dexamethasone is available in the form of a solution for injection. The preparation contains the active substance dexamethasone sodium phosphate. It differs in anti-allergic, anti-inflammatory, immunosuppressive effect. The dosage and duration of the course is prescribed by the attending physician. The drug is prohibited for use in patients with gastrointestinal diseases, viral and infectious diseases, immunodeficiency states, heart and vascular diseases, systemic osteoporosis, hepatic and renal insufficiency. Also do not use to treat pregnant women. When treating Dexamethasone, the following symptoms are possible: vomiting, hirsutism, steroid diabetes, headaches, euphoria, hallucinations, hypocalcemia, petechia, allergies.
2. Prednisolone - is available in the form of tablets and injectable solutions. The preparation contains the active substance prednisolone sodium phosphate. It differs in anti-allergic, anti-inflammatory and immunosuppressive effect. Dosage is established in accordance with the patient's condition, so it is individual. Do not take patients with viral and infectious diseases, gastrointestinal diseases, immunodeficiency states, hypoalbuminemia. Also, the drug is prohibited during pregnancy. When taking the following symptoms may occur: arrhythmia, vomiting, headaches, hirsutism, euphoria, disorientation, hypernatremia, acne, allergies.

Among non-steroidal anti-inflammatory drugs, the most effective for treatment of Dressler's syndrome are:

1. Diclofenac - the drug contains active diclofenac sodium. It differs in analgesic, anti-inflammatory and antipyretic effect. It takes one or two tablets once a day. The duration of the course is determined by the attending physician. Patients with bleeding in the gastrointestinal tract, gastrointestinal ulcers, hemophilia, intolerance to the components to take the drug is prohibited. Do not use during pregnancy. At reception possible: abdominal pain, vomiting, headaches, tinnitus, diploma, allergy, nephrotic syndrome.
2. Indomethacin is a derivative of indoleacetic acid. It differs in analgesic, anti-inflammatory, antipyretic effect. Dosage is established by the attending physician individually. Do not take indomethacin with intolerance, pancreatitis, proctitis, chronic heart failure, hypertension, during pregnancy. When taking the following symptoms may occur: nausea, headaches, tachycardia, anaphylactic reactions, allergies, mental disorders, vaginal bleeding.

In some cases, acetylsalicylic acid is used:

1. Aspirin - the preparation contains active substance acetylsalicylic acid. It differs with antipyretic, analgesic, anti-inflammatory effect. Dosage is individual and is prescribed by the attending physician. Patients with gastrointestinal ulcers, bronchial asthma, hemorrhagic diathesis, intolerance to the components to take the drug is prohibited. Do not use during pregnancy. At reception are possible: allergic reactions, headaches, dizziness, vomiting, pain in the abdomen.

Prevention

At the moment, effective measures to prevent this syndrome are not developed. Slightly reduces the possibility of developing the main symptoms of the syndrome early therapy of myocardial infarction.

[49], [50], [51], [52], [53]

Forecast

With timely and correct treatment, the prognosis is favorable. It should be understood that patients with postinfarction syndrome need to lead a correct lifestyle:

1. Correctly to eat adhering to the recommendation of dieticians - to eat fresh fruits and vegetables, juices, fruit drinks, cereals, replace animal fats with vegetable. Exclude from their diet fat meat, coffee, carbonated drinks, salted, fried, spicy and spicy dishes. Use as little salt as possible.
2. To refuse from bad habits.
3. Engage in moderate physical activity and exercise therapy (always under the supervision of the attending physician).

[54], [55], [56]