Dressler's Syndrome Research Articles

Dressler's syndrome diagnosed during surgery: lessons to be learned.

Dressler's syndrome diagnosed during surgery: lessons to be learned.

Abstract 16857: Acute Pericarditis With Concomitant Stemi Associated With Delayed Presentation in the Setting of SARS-COV-2 Pandemic

Background: The classic ST-segment elevations seen in a STEMI can similarly be found during an episode of acute pericarditis, making the two entities difficult to distinguish. The incidence of post-myocardial infarction injury syndromes presenting with findings such as acute pericarditis is estimated to be around 3%. Prompt seek of medical care is pivotal in successful outcomes, which has been affected during the pandemic. Case: A 30-year-old female with a past medical history of uncontrolled type 1 diabetes, chronic kidney disease, obesity presented with a 24-hour long history of non-radiating chest pain. Upon interrogation she endorsed that initially she delayed her coming presentation to the hospital because of fears of contracting coronavirus. Physical examination showed tachycardia and tachypnea. EKG demonstrated diffuse ST elevations in the anterolateral leads concerning for a STEMI, PR-segment depressions on most leads and troponin elevation to 0.09 ng/ml. Point of care ultrasound (POCUS) echocardiogram showed significant anterolateral wall hypokinesis. Decision making: Given her high cardiovascular risk factors the patient was urgently taken to the catheterization laboratory which found a 100% ostial left anterior descending artery and a large left main coronary artery thrombus. The thrombus was initially treated with mechanical thrombectomy and the plaque with a percutaneous coronary intervention (PCI) with a drug-eluding stent to the proximal LAD. In the days following her PCI, the patient continued to endorse sporadic sharp chest pain with the same characteristics as on presentation. Post-PCI transthoracic echocardiogram demonstrated ejection fraction of 20-25% and a small pericardial effusion. She was started on colchicine for pericarditis. She was discharged home on dual antiplatelet therapy with close follow up. Conclusion: Given that our patient had clinical pericarditis before her presentation to the hospital with a STEMI, it is unlikely that her pericarditis was due to a post myocardial infarction syndrome. Delayed presentation to the hospital associated with fear of contracting or spreading COVID-19 is a silent collateral culprit that adds up to increased cardiovascular morbidity and mortality during this pandemic.

VANISHING PLEURAL EFFUSION: DRESSLER-LIKE SYNDROME IN PATIENT WITH FOREIGN BODY REACTION

SESSION TITLE: Fellows Disorders of the Pleura Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: We describe a patient who developed bilateral right greater than left pleural effusions after surgical alteration of her prior silicone breast implants. She had near-complete resolution of her effusion with a course of non-steroidal anti-inflammatory drugs (NSAIDs). CASE PRESENTATION: We describe a 42 y/o lady, former 5.5 pack-year smoker, triple-negative breast cancer in remission, status-post bilateral mastectomy and silicone breast implantation. She since had bilateral breast reconstruction, involving superior gluteal artery perforator (SGAP) flap. She developed dyspnea and pleuritic pain within 2 weeks of her SGAP procedure, and presented to our center. She had stable vitals on admission, and did not require supplemental oxygen; however, her dyspnea and pleuritic pain were affecting her daily activities. Chest X-ray revealed a moderate right and a small left pleural effusion, confirmed on PE protocol CT scan, which was negative for PE. She was initially treated with diuretics which failed to improve her symptoms or pleural effusion size. Right thoracentesis was then performed, yielding 800 mL of serous yellow fluid. Fluid studies were consistent with an exudative effusion, with negative cytology and no bacterial or fungal growth, pH 7.48, LDH 200, glucose 88, total protein 4.1. Immediate post-procedure chest x-ray showed significant improvement in right effusion, and dyspnea was alleviated. Within 24 hours, the effusion on the right re-accumulated to a size equivalent to prior to thoracentesis. She was once again dyspneic. Suspecting an underlying inflammatory process, the patient was started on ibuprofen 600 mg QID. Within 2 days, patient felt symptomatic improvement. Outpatient follow-up chest X-ray 10 days after NSAID initiation was revealing of near-complete resolution of right effusion and symptoms. NSAID taper was then initiated. Repeat chest-XR 1 month after first dose of NSAID’s showed total resolution of pleural effusions. DISCUSSION: Foreign body reaction (FBR), or an inflammatory response to non-native entities such as breast implants, has been described as a cause of systemic release of inflammatory factors [1]. One report describes the development of pleural effusion 6 weeks after silicone breast implants [2]. We postulate the SGAP flap procedure resulted in manipulation of her prior silicone implants, resulting in an FBR. Neither IV diuretics nor therapeutic thoracentesis resulted in lasting resolution of her effusion, making fluid overload less likely. Pleural fluid studies were negative for cancer cells. The marked improvement with NSAIDs suggests an underlying systemic inflammatory response, not unlike Dressler’s Syndrome. CONCLUSIONS: Clinicians should be aware of pleural effusions that are secondary to a foreign body reaction, and consideration of a course of non-steroidal anti-inflammatory drugs should be considered if other causes of effusion have been ruled out. Reference #1: Tralhão, António et al. “The return of a disappearing entity: Dressler's syndrome after transvenous pacemaker implantation.” BMJ case reports vol. 2014 bcr2013203401. 20 Mar. 2014, doi:10.1136/bcr-2013-203401 Reference #2: Silicone Breast Implants: A Rare Cause of Pleural Effusion Shaik, Imam et al. CHEST, Volume 148, Issue 4, 444A DISCLOSURES: no disclosure on file for Alexander Geyer; No relevant relationships by Saamia Hossain, source=Web Response

Случай развития синдрома Дресслера у больного с острым диффузным миокардитом

Описан клинический случай развития классического синдрома Дресслера у молодого пациента с острым диффузным миокардитом. Своевременная диагностика, назначение глюкокортикоида и проведение длительной комплексной терапии с применением β-адреноблокаторов (карведилол), блокаторов минералокортикоидных рецепторов (эплеренон) привело не только к исчезновению проявлений синдрома Дресслера, но и к достаточно быстрому выздоровлению больного от основного заболевания.

Cardiac Tamponade in a Patient With Myocardial Infarction and COVID-19: Electron Microscopy

We present the case of a patient with myocardial infarction and COVID-19 disease who developed hemorrhagic pericardial effusion and cardiac tamponade. The differential diagnosis included post-infarction pericarditis and mechanical complications, thrombolysis, Dressler syndrome, and viral pericarditis. The histopathologic examination of the pericardial tissue sample and electron microscopic examination established the diagnosis. (Level of Difficulty: Advanced.)

POSTMYOCARDIAL INFARCTION SYNDROME: INPATIENT CONTEMPORARY FEATURES OF A FORGOTTEN CONDITION IN THE POST PERCUTANEOUS CORONARY INTERVENTION ERA

Postmyocardial Infarction Syndrome (PMIS), or Dressler's syndrome, refers to a heterogeneous group of autoimmune-mediated conditions of pericardial, epicardial and myocardial inflammation following myocardial infarction. Generally considered to be rare in the reperfusion era, the features and risk

Coronary Artery Disease: From Mechanism to Clinical Practice.

In most developed countries, coronary artery disease (CAD), mostly caused by atherosclerosis of coronary arteries, is one of the primary causes of death. From 1990s to 2000s, mortality caused by acute MI declined up to 50%. The incidence of CAD is related with age, gender, economic, etc. Atherosclerosis contains some highly correlative processes such as lipid disturbances, thrombosis, inflammation, vascular smooth cell activation, remodeling, platelet activation, endothelial dysfunction, oxidative stress, altered matrix metabolism, and genetic factors. Risk factors of CAD exist among many individuals of the general population, which includes hypertension, lipids and lipoproteins metabolism disturbances, diabetes mellitus, chronic kidney disease, age, genders, lifestyle, cigarette smoking, diet, obesity, and family history. Angina pectoris is caused by myocardial ischemia in the main expression of pain in the chest or adjoining area, which is usually a result of exertion and related to myocardial function disorder. Typical angina pectoris would last for minutes with gradual exacerbation. Rest, sit, or stop walking are the usual preference for patients with angina, and reaching the maximum intensity in seconds is uncommon. Rest or nitroglycerin usage can relieve typical angina pectoris within minutes. So far, a widely accepted angina pectoris severity grading system included CCS (Canadian Cardiovascular Society) classification, Califf score, and Goldman scale. Patients with ST-segment elevated myocardial infarction (STEMI) may have different symptoms and signs of both severe angina pectoris and various complications. The combination of rising usage of sensitive MI biomarkers and precise imaging techniques, including electrocardiograph (ECG), computed tomography, and cardiac magnetic resonance imaging, made the new MI criteria necessary. Complications of acute myocardial infarction include left ventricular dysfunction, cardiogenic shock, structural complications, arrhythmia, recurrent chest discomfort, recurrent ischemia and infarction, pericardial effusion, pericarditis, post-myocardial infarction syndrome, venous thrombosis pulmonary embolism, left ventricular aneurysm, left ventricular thrombus, and arterial embolism.

P1480 A case of triple left ventricular aneurysms diagnosed by CT and echocardiography

Abstract 【Background】 Left ventricular aneurysms is complication of myocardial infarction (MI) that can lead to death or serious morbidity. False aneurysm is rare complications of myocardial infarction or iatrogenic perforation and represent a contained myocardial rupture. False aneurysm does not contain all the three layers of the myocardium and is frequently lined by pericardium and mural thrombus. Definitive diagnosis is achieved by echocardiography, computed tomography (CT), angiography, or magnetic resonance imaging. Coexistence of true and false aneurysms is rare. 【Case】 A 58 years old man with a history of hypertension and MI was referred to our hospital for aneurysmectomy. During the course of prior MI, he got fever and pericardial effusion. CT revealed that three left ventricular aneurysms were present. Also, three aneurysms were connected by narrow ducts each other. Transthoracic echocardiography (TTE) revealed that three ventricular aneurysms were connected via acceleration blood flow which swirling in the spherical aneurysm. We determined that this triple ventricular aneurysms were at high risk for rupture, so we performed surgery. The postoperative course was good and he was discharged without any complications. 【Discussion】 False aneurysms occur after hemorrhagic dissection into an area of transmural infarction and most commonly result in free intrapericardial rupture of the heart, cardiac tamponade, and death. Rarely, if the overlying pericardium becomes adherent to the epicardium along the surface of the infarct, it can contain the rupture. We were able to evaluate the mechanism of development with triple left ventricular aneurysms using CT and TTE. We could know about spatial comprehension of triple aneurysms using CT. False aneurysms were restricted enlargement due to stiff pericardium because of complicating Dressler syndrome. We hypothesis that aneurysms were enlarging in the direction of the base of heart in the adhered pericardium space. We were able to evaluate the thickness of aneurysms and blood flow condition using TTE. TTE revealed that the wall of aneurysm was fragile. Multimodality imaging like TTE or cardiac CT are useful diagnostic methods in this case. Abstract P1480 Figure. Triple aneurysms

Enhancing Prediction Models for One-Year Mortality in Patients with Acute Myocardial Infarction and Post Myocardial Infarction Syndrome.

Predicting the risk of mortality for patients with acute myocardial infarction (AMI) using electronic health records (EHRs) data can help identify risky patients who might need more tailored care. In our previous work, we built computational models to predict one-year mortality of patients admitted to an intensive care unit (ICU) with AMI or post myocardial infarction syndrome. Our prior work only used the structured clinical data from MIMIC-III, a publicly available ICU clinical database. In this study, we enhanced our work by adding the word embedding features from free-text discharge summaries. Using a richer set of features resulted in significant improvement in the performance of our deep learning models. The average accuracy of our deep learning models was 92.89% and the average F-measure was 0.928. We further reported the impact of different combinations of features extracted from structured and/or unstructured data on the performance of the deep learning models.

75-Year-Old Man With Chest Pain and Dyspnea

75-Year-Old Man With Chest Pain and Dyspnea

Факторы риска развития синдрома Дресслера.

Факторы риска развития синдрома Дресслера.

Newer evidences and recommendations in lipidology

The correlation between cholesterol and risk reduction is unique: no J curve is seen even at extreme low levels. According to PRECISE-IVUS, the effect of intensive cholesterol lowering on plaque regression is more pronounced post-myocardial infarction syndrome than in chronic coronary disease. The importance of LDL-C lowering with ezetimibe in IMPROVE-IT (1.4 mmol/L compared to 1.8 mmol/L in the statin monotherapy arm) is expressed in several international guidelines and the indication spectrum of combination cholesterol lowering has broadened and strengthened. There is a strong evidence that myalgia during statin treatment is generally not caused by statins and it is not related to type or dose of the drug. With patience, the majority of patients can be made to become statin takers even with good quality of life; for those who cannot, ezetimibe monotherapy can be an alternative. Even though intensive cholesterol lowering is safe, avoiding statin myopathy should be emphasized. Despite the outstanding efficacy and safety of cholesterol lowering, Hungarian statin sales have decreased recently, in which driven dilettante public climate around the products may be of utmost importance. Everyone of us should counteract this according to the possibilities. Orv Hetil. 2018; 159(32): 1303-1309.

Acute post cardiac injury syndrome occurring immediately after a demanding percutaneous coronary intervention.

Postcardiac injury syndrome (PCIS) occurs as a complication of myocardial infarction (Dressler's syndrome), of cardiac surgery (post-pericardiotomy syndrome), or post-traumatic (either iatrogenic or non-iatrogenic) and involves a pericardial or myocardial injury. There is scarce data regarding occurrence and pathogenesis of PCIS after invasive procedures. Herein, we describe a unique case of acute PCIS with typical clinical, laboratory, echocardiographic findings that occurred one hour after a demanding multi-stenting percutaneous coronary intervention. Possible pathogenetic mechanisms and treatment options are being discussed.

Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE.

During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.

Pleural effusions in acute idiopathic pericarditis and postcardiac injury syndrome.

Pleural effusions are frequent in the context of acute idiopathic pericarditis and following pericardiotomy, but they have seldom been characterized. This review summarizes their most relevant clinical features. In acute idiopathic pericarditis, pleural effusions tend to be left-sided and, if bilateral, they are usually larger on the left. Less than 5% are unilateral right-sided. About 90% of the effusions occupy less than one-third of the hemithorax, and 99% meet Light's exudative criteria with a predominance of lymphocytes in three fourths of the cases. Although postcardiac injury syndrome (PCIS)-related effusions share similar characteristics, they present some differential features: more than 15% are unilateral on the right (except for Dressler syndrome), one-fourth opacify half or more of the hemithorax, and nearly two thirds are bloody. The combination of nonsteroidal anti-inflammatory drugs and colchicine, along with therapeutic thoracenteses for moderate-to-large effusions, is the mainstay treatment approach. The postoperative use of colchicine is also a reasonable option for preventing PCIS in patients who have undergone cardiac surgery. Pleural effusions because of pericardial diseases remain a clinical diagnosis. If unilateral right-sided, massive, or transudative effusions are seen, an alternative diagnosis to acute pericarditis should be considered.

Analysis of risk factors of postmyocardial infarction syndrome in female patients with acute coronary syndromes

Objective To analyze the risk factors of postmyocardial infarction syndrome(PMIS)to female patients with acute coronary syndromes(ACS). Methods 258 female patients with ACS complicated with myocardial infarction were selected, of whom 24 patients with PMIS. The clinical data of the two groups were compared and made Logistic regression analysis with different factors to get independent risk factors for PMIS. Results Of 258 female patients with ACS complicated with myocardial infarction, 24 patients with PMIS, the proportion was 9.30%. The age, infarct size, fibrinogen(FIB) level, creatine kinase isoenzymes(CK-MB) level and troponin I(cTnI) level of PMIS group were (64.95±4.95)years old, (11.65±1.52)cm, (2, 6.91±1.86)g/L, (36.91±2.46)ng/L, (8.91±1.54)ng/L, respectively, which were higher than those in non-PMIS group[(56.18±4.83)years old, (8.83±1.49)cm2, (5.41±1.58)g/L, (33.88±2.25)ng/L, (6.40±1.17)ng/L](t=8.452, 8.814, 4.354, 6.229, 9.695, all P﹤0.05). The proportion of patients with smoking and drinking habits, proportion of patients with underlying diseases, proportion of patients with chronic pulmonary disease, proportion of patients with heart and stalk history, proportion of patients with Killip grade Ⅲ-Ⅳ were 16.67%, 37.50%, 20.83%, 66.67%, 66.67%, respectively, which were higher than those in non-PMIS group (4.70%, 11.97%, 8.97%, 31.20%, 31.20%, χ2=5.692, 11.553, 4.378, 12.120, 7.172, all P﹤0.05). Logistic regression analysis showed that basic disease, history of myocardial infarction, infarct size, Killip classification, CK-MB level and cTnI level were independent risk factors for PMIS. Conclusion The combination of basic disease, history of myocardial infarction, larger infarct size, higher Killip classification, high CK-MB level and high cTnI level can increase the risk of PMIS in female patients with ACS. Key words: Acute coronary syndromes; Postmyocardial infarction syndrome; Risk factor

Pericardial and myocardial disease.

Download the Issue @ a Glance podcast Subscribe to the EHJ Podcast ![Graphic][1] Diseases of the pericardium are particularly common in patients with infectious, inflammatory or rheumatic diseases, as well as in those with certain forms of cancer, and is a condition that is often not easy to diagnose, as it may mimic an acute coronary syndrome,1,2 or to treat.3–5 In contrast, post-infarction pericarditis has become quite rare with modern urgent primary percutaneous coronary procedures. Frequently pericardial inflammation or infection also involves the myocardium, causing myocarditis, a common precursor of certain forms of non-ischaemic cardiomyopathies. Indeed, myocarditis may impair left ventricular function6 due to marked inflammation with secretion of cytokines,7 with sometimes a fulminant clinical course.8 Although myocardial biopsies may help in the diagnosis,9 effective treatment strategies are still missing. In addition, dilated cardiomyopathies may develop due to genetic and unknown factors. Mutations in mitochondrial genes may cause a variety of clinical symptoms in the brain, eye, and peripheral and cardiac muscle.10–12 In the clinical research paper entitled ‘ Long-term cardiac prognosis and risk stratification in 260 adults presenting with mitochondrial diseases ’ by Karim Wahbi from the Cochin Hospital in Paris, France,13 … [1]: /embed/inline-graphic-1.gif

Dressler Syndrome: A Case Report

Introduction: Dressler Syndrome should be considered in the differential diagnosis of chest pain, especially in patients who are in a late stage of the evolution of the ischemic process. Case Presentation: A 46-year-old male was admitted to the emergency department due to pleuritic chest pain. Two weeks before this admission, he presented with a typical angina episode, likely an ST segment elevation myocardial infarction (STEMI), and did not receive reperfusion therapy or any medical care. The patient’s electrocardiogram showed diffuse ST segment elevation and PR segment depression, and his blood tests showed positive myocardial necrosis markers. A coronary angiography showed a proximal occlusion (not recanalized) of the circumflex artery. There was a late gadolinium enhancement area seen through cardiac magnetic resonance imaging (CMR), suggestive of recent transmural infarction, pericardial injury, and pleural effusion (inflammatory). Conclusions: These findings strongly suggest the diagnosis of delayed post-infarction pericarditis, or Dressler Syndrome, a rare disease in the age of reperfusion therapy. Although rare, it is a syndrome that must be considered in the differential diagnosis of chest pain.

Pacemaker Induced Post Cardiac Injury Syndrome

Post pacemaker insertion pericarditis is a rare form of post cardiac injury syndrome. It is an inflammatory process involving the pericardium and/or pleura due to a recent cardiac injury. Post cardiac injury syndrome may develop after myocardial infarction (Dressler syndrome), cardiac surgery or trauma. However, in rare cases it can occur following minor cardiac procedures. We report a case of a 74-year-old male with post-cardiac injury syndrome 4 weeks post permanent pacemaker implantation. A high index of suspicion in addition to ordering appropriate imaging studies and device interrogation are crucial to establish correct diagnosis and rule out lead perforation.

Fever after acute myocardial infarction: Dressler's syndrome demonstrated on cardiac MRI

Fever after acute myocardial infarction: Dressler's syndrome demonstrated on cardiac MRI