Acute myocarditis can lead to Dressler syndrome: A Case Report

A patient went to the hospital due to persistent febrile temperatures. Positive blood cultures for Enterococcus faecalis as well as a vegetation on the mitral valve in the echocardiography were detected. Therefore the diagnosis of E. faecalis endocarditis was made. An appropriate antimicrobial combination therapy with amoxicillin and gentamicin was initiated. During the course of treatment, gentamicin was switched to ceftriaxone because of an acute kidney injury KDIGO stadium AKI 1. Furthermore a mechanical mitral valve replacement was performed. After a continuous 5-week antimicrobial therapy, the patient was urgently transferred back from cardiological rehabilitation to the hospital due to acute flank pain with emesis.Clinically, the 64-year-old patient presented with tenderness in the right abdomen. Laboratory tests revealed acute kidney injury AKI 3 with microhematuria in the urine analysis. Sonographically, there was evidence of hydronephrosis in the right kidney. An abdominal CT revealed a calculus in the urinary bladder.The calculus, measuring 7 × 3 × 2 mm, was expelled through micturition and consisted 100% of amoxicillin. Therefore, the diagnosis of amoxicillin-induced urolithiasis was made.The antimicrobial therapy with amoxicillin was adjusted according to kidney function. Due to an initially unclear inflammatory condition associated with Dressler syndrome, the combination therapy was completed after 8 weeks instead of 6 weeks. At this time, the creatinine level was slightly elevated. After two weeks, it was back within the normal range. Two years later, the patient is free from recurrence of endocarditis.In the case of intrarenal precipitation of crystals, crystal nephropathy occurs, which presents a rare side effect of amoxicillin. As in this case, massive precipitation of macroscopic crystals in the renal pelvis can even lead to urolithiasis with obstructive nephropathy. This case demonstrates the importance of regular monitoring of renal function during treatment with amoxicillin, particularly in high-dose therapy with prolonged treatment duration.

The operation to close a ventricular septal defect with an occluder is a minimally invasive procedure performed through a transvascular approach. The occluder is introduced via the femoral vein or artery and transported to the site of the defect, where it is deployed to close the hole in the ventricular septum, preventing pathological blood shunting. The advantage of this technique is its minimal invasiveness, rapid patient recovery, and reduced risk of complications compared to open surgery. This article presents a clinical case of successful treatment of this pathology, confirming the importance of timely intervention in post-infarction ventricular septal rupture to improve patient’s survival and functional status. The minimally invasive closure of the defect with an occluder, used in this case, proved effective in stabilizing the patient with Dressler syndrome and subsequent preparing for coronary artery bypass grafting.

Post-Cardiac Injury Syndrome (PCIS) refers to a collective term encompassing post-myocardial infarction syndrome, post-pericardiotomy syndrome, and post-traumatic pericarditis. With an aging population, the incidence of PCIS is on the rise annually. This condition is considered to be an autoimmune-mediated inflammatory response leading to pericarditis as the primary manifestation of the cardiac disease. Early diagnosis and effective treatment can improve the quality of life and prognosis for PCIS patients. This review aims to provide a comprehensive explicit of the epidemiological characteristics, relevant pathophysiological mechanisms, diagnostic methods, and treatment strategies associated with PCIS, further fostering a deeper understanding and promoting advancements in the prevention and treatment of PCIS.

HighlightsThe frequency of Dressler syndrome decreased sharply from 20 to less than 5% with the introduction of early reperfusion into clinical practice. Relapses of Dressler’s post-infarction syndrome are quite common. The review presents current literature data on the etiology and pathogenesis, diagnostic methods and various approaches to the treatment of Dressler syndrome, including the effectiveness of colchicine and reports on the use of immunoglobulins. AnnotationThe development of Dressler syndrome relapses within 1 year after the first occurrence of the event, despite the decrease in the frequency of the disease, emphasizes the relevance of the problem under consideration. Dressler syndrome is based on autoimmune genesis. Echocardiography is the “gold standard” of instrumental diagnostics and the most sensitive imaging method for suspected Dressler syndrome, but in some cases magnetic resonance imaging may be effective. There is currently no single treatment regimen for autoimmune pericarditis. Most literature sources indicate the most frequent use of nonsteroidal anti-inflammatory drugs, glucocorticosteroids and colchicine. The article highlights the literature data on etiology, modern views on pathogenesis, current methods of diagnosis of Dressler syndrome and various approaches to treatment tactics and drug selection. The following resources were used: eLIBRARY.ru, PubMed. The keywords were as follows: “Dressler syndrome”, “postinfarction syndrome”, “postpericardiotomy syndrome”, “myocardial infarction”. The articles published primarily in the last 5 years (2017-2022) were preferred.

Dressler syndrome - a delayed complication of myocardial infarction.

Postmyocardial syndrome (Dressler syndrome) is a form of secondary pericarditis with or without pericardial effusion resulting from myocardial damage. Dressler syndrome is not a common disease, but it should be suspected in patients with pathognomonic symptoms after a myocardial infarction (MI). The article presents a clinical case of a 65-year-old man, a smoker who is overweight, with a history of hypertension, MI with ST segment elevation, stenting of the envelope branch of the left coronary artery, thrombospiration. According to coronary angiography, the patient revealed a multivessel lesion of the coronary arteries. Two weeks after stenting, the patient’s condition worsened: shortness of breath, pain in the left half of the chest, fever appeared. During the examination at the outpatient stage, bilateral hydrothorax and hydropericardium were revealed. He was hospitalized, was treated with ibuprofen 600 mg 3 times a day for 7 days, with a positive effect. Ten days after discharge, the patient noted an increase in shortness of breath, an increase in body temperature, a recurrence of dull chest pain. He was hospitalized at the Vorokhobov City Clinical Hospital No. 67, where bilateral hydrothorax, hydropericardium, pneumonitis were detected during the examination. the diagnosis "Postmyocardial syndrome, recurrent course" was established. Hospital treatment was carried out with colchicine, methylprednisolone, acetylsalicylic acid, ticagrelor, losartan, bisoprolol, amlodipine, spironolactone. Against the background of the therapy, the condition improved, the patient began to notice an increase in exercise tolerance, a gradual regression of dull chest pain on the left, body temperature decrease to subfebrile figures. Positive dynamics of laboratory parameters was noted.

Inspiratory Chest Pain and Fever after Acute Myocardial Infarction: Dressler's Syndrome Demonstrated on Cardiac MRI

The benefits of minimally invasive techniques in cardiac surgery remain poorly defined. We evaluated the short- and mid-term outcomes after surgical aortic valve replacement through partial upper versus complete median sternotomy (MS) in a large, German multicenter cohort. A total of 2,929 patients underwent isolated surgical aortic valve replacement via partial upper sternotomy (PUS, n = 1,764) or MS (n = 1,165) at nine participating heart centers between 2016 and 2020. After propensity-score matching, 1,990 patients were eligible for analysis. The primary end point was major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction, and stroke at 30 days and in follow-up, up to 5 years. Secondary end points were acute kidney injury, length of hospital stay, transfusions, deep sternal wound infection, Dressler's syndrome, rehospitalization, and conversion to sternotomy. Unadjusted MACCE rates were significantly lower in the PUS group both at 30 days (p = 0.02) and in 5-year follow-up (p = 0.01). However, after propensity-score matching, differences between the groups were no more statistically significant: MACCE rates were 3.9% (PUS) versus 5.4% (MS, p = 0.14) at 30 days, and 9.9 versus 11.3% in 5-year follow-up (p = 0.36). In the minimally invasive group, length of intensive care unit (ICU) stay was shorter (p = 0.03), Dressler's syndrome occurred less frequently (p = 0.006), and the rate of rehospitalization was reduced significantly (p < 0.001). There were 3.8% conversions to full sternotomy. In a large, German multicenter cohort, MACCE rates were comparable in surgical aortic valve replacement through partial upper and complete sternotomies. Shorter ICU stay and lower rates of Dressler's syndrome and rehospitalization were in favor of the partial sternotomy group.

Dressler Syndrome, also known as post-myocardial infarction syndrome, is a rare but potentially serious complication that occurs following myocardial infarction or cardiac surgery. It is characterized by pericarditis, pleuritis, and fever, typically presenting weeks to months after the initial event. This article provides a comprehensive review of Dressler Syndrome, including its pathophysiology, clinical presentation, diagnosis, and management. Additionally, it discusses the importance of early recognition and appropriate treatment to prevent complications and improve outcomes.

Postcardiac injury syndrome (PCIS) serves as a comprehensive term encompassing a spectrum of conditions, namely postpericardiotomy syndrome, postmyocardial infarction (MI) related pericarditis (Dressler syndrome), and post-traumatic pericarditis stemming from procedures like percutaneous coronary intervention or cardiac implantable electronic device placement. These conditions collectively give rise to PCIS, triggered by cardiac injury affecting pericardial or pleural mesothelial cells, leading to subsequent inflammation syndromes spanning from uncomplicated pericarditis to substantial pleural effusion. A thorough literature search conducted on MEDLINE/PubMed utilizing search terms including "postacute cardiac injury syndrome," "postcardiac injury syndrome," "postcardiotomy syndrome," "postpericardiotomy syndrome," and "post-MI pericarditis" was instrumental in collating pertinent studies. To encapsulate the amassed evidence, relevant full-text materials were meticulously selected and amalgamated narratively. The pathophysiology of PCIS is proposed to manifest through an autoimmune-mediated process, particularly in predisposed individuals. This process involves the development of anti-actin and antimyosin antibodies after a cascade of cardiac injuries in diverse forms. Treatment strategies aimed at preventing recurrent PCIS episodes have shown efficacy, with colchicine and nonsteroidal anti-inflammatory drugs, including ibuprofen, demonstrating positive outcomes. Conversely, corticosteroids have exhibited no discernible benefit concerning prognosis or recurrence rates for this ailment. In summary, PCIS serves as a unifying term encompassing a spectrum of cardiac injury-related syndromes. A comprehensive review of relevant literature underscores the autoimmune-mediated pathophysiology in susceptible individuals. The therapeutic landscape involves the proficient use of colchicine and Nonsteroidal anti-inflammatory drugs to deter recurrent PCIS episodes, while corticosteroids do not appear to contribute to improved prognosis or reduced recurrence rates. This nuanced understanding contributes to an enhanced comprehension of PCIS and its multifaceted clinical manifestations, potentially refining its diagnosis and management.

BackgroundCoronary stent infections are an uncommon but deadly complication of percutaneous coronary intervention. Mortality remains as high as 40–60% even with adequate treatment. We report such an interesting case of left circumflex stent (LCX) infection and mycotic aneurysm that was successfully managed with antibiotics and surgery.Case presentationA middle-aged man who underwent percutaneous coronary intervention (PCI) to the left circumflex artery four weeks prior was referred as a case of pyrexia of unknown origin, not responding to antibiotics, and colchicine started for suspected Dressler syndrome. Although the inflammatory markers were elevated, the results of the blood culture did not show any growth. Echocardiography showed a doubtful echogenic structure in the left atrioventricular groove and mild pericardial effusion, and a stent infection was suspected. PET scan showed focal metabolic activity in the region of the LCX stent, with metabolically active supraclavicular and paratracheal lymph nodes, and a coronary angiogram revealed an aneurysm arising distal to the stented LCX. A diagnosis of stent infection and associated mycotic aneurysm was made, and the patient underwent surgery which included aneurysm repair, stent retrieval, and coronary artery bypass graft (CABG) to the major and terminal OM. The postoperative course was uneventful, and the patient was discharged without complications.ConclusionsIt is important to investigate the possibility of coronary stent infection in individuals experiencing prolonged fever following PCI. PET scans and coronary angiograms can aid in diagnosis when echocardiograms are inconclusive. Adequate antibiotic therapy and timely surgery are crucial for successfully managing coronary stent infections.

The purpose — to present a clinical case of diagnosing the autoimmune postinfarction syndrome (Dressler syndrome). Material and methods. The medical documentation of a patient with myocardial infarction complicated by Dressler syndrome was analyzed. Results. The clinical case presents a patient with acute extensive anterior myocardial infarction who sought medical help on the 2nd day of the disease, which may have caused the autoimmune postinfarction syndrome on the 11th day of the disease (fibrinous exudative pericarditis, focal pneumonia, eosinophilia and laboratory signs of inflammation). The patient’s low adherence to the treatment during hospitalization contributed to the subsequent development of coronavirus infection. Conclusion. The publication is of interest to cardiologists, doctors of functional and radiation diagnostics. The diagnosis of Dressler syndrome is based mainly on the results of laboratory and instrumental research methods as the onset and course of Dressler syndrome most often has a poor clinical picture.

We present a case report of a 47-year-old male with a known history of recent diabetes who presented with symptoms suggestive of Dressler syndrome, along with the incidental finding of a left ventricular aneurysm. Dressler syndrome is a delayed immune-mediated response following myocardial injury, commonly observed post-myocardial infarction (MI) or cardiac surgery. This case highlights the importance of recognizing the atypical presentation of Dressler syndrome and its association with complications such as ventricular aneurysm, particularly in patients with pre-existing comorbidities.

Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious complication after cardiac surgery. The influence of statin use before surgery on the renal outcome of patients undergoing cardiac surgery is controversial. The purpose of this study was to evaluate the effect of statins on postoperative renal outcomes in patients undergoing cardiac surgery. Methods: We included CSA-AKI patients in the Medical Information Mart for Intensive Care (MIMIC)-IV database and were divided into statin group and non-statin group according to whether they used statins before entering intensive care units (ICU). The main outcomes were hospitalization and 30-day mortality, and the secondary outcomes were 60-day mortality and 90-day mortality. We used propensity score matching (PSM) to adjust for confounding factors. The 95% confidence interval (CI) and risk ratio (RO) were calculated by the COX proportional regression model. At the same time, stratified analysis was used to explore whether the relationship between the statins use before intensive care units and mortality was different in each subgroup and whether the relationship between different doses of Atorvastatin and mortality was different. Result: We identified 675 pre-ICU statin users and 2095 non-statin users. In the COX proportional regression model, pre-ICU statin use was associated with decreased in-hospital (HR = 0.407, 95%confidence interval 0.278-0.595, p < 0.001) and 30-day mortality (HR = 0.407, 95%CI 0.279-0.595, p < 0.001). The survival rate of patients who took statins before entering ICU was significantly higher than that of those who did not use statins at 30days, 60days and 90days. There is a significant interaction between patients with aged>65years (HR = 0.373, 95%CI 0.240-0.581, p < 0.001), Acute kidney injury grade I (HR = 0.244, 95%CI 0.118-0.428, p < 0.001), and without post-myocardial infarction syndrome (HR = 0.344, 95%CI 0.218-0.542, p < 0.001). The mortality in hospital and 60days of CSA-AKI patients treated with ≥80mg Atorvastatin before operation was significantly reduced (p < 0.05). Conclusion: The pre-ICU statin use was significantly associated with decreased risk in hospital and 30-day mortality. The preoperative use of ≥80mg Atorvastatin may improve the prognosis of CSA-AKI.

Dressler syndrome is a type of secondary pericarditis that can be accompanied by pleural effusion or pericardial effusion resulting from injury of the pericardium or heart tissue. A 33-year-old male was admitted to the emergency department with pleuritic chest pain radiating to both shoulders and fever. Two months before the admission, the patient underwent traditional open-heart surgery with median sternotomy and pericardiectomy for atrial septal defect (ASD) closure. Blood tests showed elevated acute phase reactants (leukocytosis, high erythrocyte sedimentation rate, and C-reactive protein). Left-sided pleural effusion was revealed on chest CT scan. Diagnosis of Dressler syndrome was established. The patient’s pleuritic chest pain and shoulder pain improved clinically with a short course of colchicine. Although Dressler syndrome is rarely seen, it should be considered in the differential diagnosis of pleuritic chest pain. Special attention should be paid to Dressler’s syndrome because pericarditis can develop following cardiac surgery.

Dressler syndrome after myocardial infarction: a case report

Gabrielė Žūkaitė1, Rasa Šimoniūtytė2 1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania 2Vilnius City Clinical Hospital, Department of Internal Medicine, Vilnius, Lithuania Abstract Background. Dressler syndrome (DS) occurs as a result of injury to the heart or pericardium, usually 1 to 6 weeks after a myocardial infarction. The incidence is decreasing due to advanced treatment methods. Pathogenesis still remains unclear, but it is associated with autoimmune processes. Clinical DS symptoms are fever, pleuritic chest pain, and fluid in pericardial and/or pleural space (pericardial rub and murmurs may be heard). Aim: to select and analyze the latest diagnostic and treatment recommendations for DS based on the experience of researchers and to discuss the etiology, pathogenesis and clinical symptoms. Material and methods. A review of medical literature was performed using databases of PubMed, Elsevier, Google Scholar, and guidelines of European Society of Cardiology. The search was performed using the following keywords and combinations in English: Dressler syndrome, pericarditis, post-cardiac injury syndrome. Results. DS can be diagnosed if two of the five diagnostic criteria are present (fever without other alternative causes, pericardial or pleural pain, pericardial or pleural effusion, fluid in pericardium or pleura, and/or increased C-reactive protein). The first-line treatment is non-steroidal anti-inflammatory drugs in combination with colchicine. In treatment-resistant DS, glucocorticoids are given without discontinuing colchicine. If recovery is not achieved even with second-line treatment, immunomodulators or intravenous immunoglobulin are prescribed, and as a last resort, pericardiectomy is performed. Conclusion. DS has favorable prognosis if diagnosed in time, but there is a possibility of recurrence of the syndrome (colchicine is an approved medication for prevention). Keywords: Dressler syndrome, pericarditis, post–cardiac injury syndrome. Full article https://doi.org/10.53453/ms.2023.2.20

Aim. To compare structural and functional left ventricular (LV) changes in the early period of myocardial infarction (MI) within 20 years on the basis of the Emergency Cardiology Department of the Cardiology Research Institute (Tomsk).Material and methods. The study included two groups of patients who were treated at different periods of time with an interval of 20 years. Group 1 included 83 patients who had ST-segment elevation MI (STEMI) in 1997-1999, while group 2 — 83 patients with STEMI from 2019-2020. Echocardiography was performed during the first 72 hours from hospitalization and on the 7-10th day. Depending on the increase in LV end-diastolic volume (EDV) by &gt;15% by the 7-10th day, the patients were divided into 2 subgroups: with remodeling (LVR+) and without remodeling (LVR-).Results. Patients of the 2nd group were older, with a larger proportion of females and with a high incidence of risk factors for coronary artery disease compared with patients of the 1st group. In the early postinfarction period among patients of the 2nd group, acute LV aneurysm, early postinfarction angina and Dressler syndrome developed less frequently. The proportion of adverse LV remodeling in patients of the 1st group was higher (32,8% vs 17%), and while the percentage of reverse remodeling was lower (10% vs 24%), p&lt;0,05. Comparison of the absolute values of LV EDV, end-systolic volume (ESV) and ejection fraction (EF) at baseline and after 7 days, as well as their increase showed higher intensity of post-infarction remodeling in group 1 patients. In patients of the 1st group, there was a progression of LV remodeling (Me ΔEDV — 12,2%) with a deterioration in LV contractility by the 7th day (Me ΔESV — 14%), while in patients of the 2nd group during the first 7 days of MI, there were more stable LV EDV and ESV (p&gt;0,05) and an increase in LVEF (p=0,03) before discharge.Conclusion. In the present era of primary percutaneous coronary intervention and pharmacological treatment of MI, early adverse LV remodeling develops less frequently and is characterized by less pronounced left heart dilatation.

The purpose is to present a literature review on a rather rare pathology — Dressler syndrome, paying special attention to one of its main components — pericarditis. Material and methods. Russian and foreign literature on Dressler syndrome were studied, with special attention to the sources over the recent 10 years. Results. A review of the medical literature on the topic — Dressler syndrome is presented, describing the concept, etio-pathogenetic aspects, classification, epidemiology, a brief historical background, clinical picture, laboratory and instrumental features, and tactics of patient management. Conclusion. Dressler syndrome is understood as a symptom complex that occurs due to myocardial damage of various genesis with the development of autoimmune aggression and subsequent hyperergic reaction with benign lesion of serous membranes, leading to the appearance of pericarditis, pleurisy, pneumonitis and other symptoms. The initial clinical manifestations and the subsequent course of this syndrome, as a rule, are often unexpressed. Therefore, a timely assessment of clinical and instrumental data that go beyond the usual course of the post-infarction / postoperative period, as well as the effect of the therapy used, contributes to the timely diagnosis of this syndrome and, accordingly, the appointment of adequate pathogenetic therapy.