From this article you will learn: what is Dressler's syndrome, how this post-infarct complication develops. Causes, risk factors, underlying symptoms. Methods of treatment and prognosis for recovery.
The pathogenesis mechanism
Dressler's syndrome is called an autoimmune complication, which develops after a time( 1 to 6 weeks) after a heart attack.
What happens if I have a pathology? Myocardial infarction is an attack of acute ischemia( oxygen starvation) of cardiac muscle cells( cardiomyocytes), as a result of which they die. In their place, a site of necrosis is formed, and then a scar from the connective tissue. In this case, a specific protein( pericardial and myocardial antigens) enters the bloodstream - the result of the cellular decay of cardiomyocytes.
Since there are very few such antigens in a healthy body, and with a massive infarction a massive outburst occurs - the body starts producing antibodies against them. As a result, all protein structures similar in structure( located mainly in the cell membranes) are attacked by the immune system of their own organism. This is how the autoimmune reaction to healthy cells and tissues of the body develops.
Pathology affects synovial articular bags, pleura, pericardium and other organs, causing various inflammations of connective tissue of aseptic nature( aseptic - that is, without the participation of viruses and bacteria):
- Pericarditis( inflammation of the serous membrane of the heart).
- Pleuritis( inflammation of the serous lung membrane).
- Pneumonitis( aseptic pneumonia).
- Autoimmune arthritis of the shoulder joint( inflammation of the joint).
- Peritonitis( inflammation of the peritoneum).
- Skin manifestations by type of allergic( hives, dermatitis, erythema).
By itself, postinfarction syndrome is not life-threatening even in the most severe course( prolonged, often repeated form), worsens the patient's quality of life and ability to work temporarily( the sick-list for temporary disability is issued for a period of 3 months).
Autoimmune diseases, including postinfarction syndrome, in most cases become chronic( 85%) and have a peculiarity of recurrence( return).Only in 15% of cases the disease is completely cured.
Paterson with Dressler's syndrome is observed and treated by a cardiologist.
Mechanism for the development of pathology
An autoimmune reaction is directed toward the protein structures of cell membranes, located mainly in the membranes of the organs( pleura, pericardium, synovial bags of joints, sometimes peritoneum, skin).The body produces lymphocytes that bombard healthy cells, trying to destroy them( destroy, dissolve).
Connective tissue becomes inflamed, causing disorganization of the body, pain and various symptoms( cough with pleurisy).
Dressler's syndrome develops some time after a heart attack. Symptoms can appear in a week( early) or in 8 months( late) after an attack, but usually begin at 2-6 weeks.
- in the form of short acute periods( 2 to 5 weeks, with severe symptoms) and months of remission( signs of the disease are strongly erased or do not manifest at all) - 85%;
- in the form of an acute period( 2 to 6 weeks), which is followed by a full recovery - 15%.
Causes of the onset
The cause of the appearance of the Dressler syndrome - foci of necrosis as a result of:
- large-focal or complicated myocardial infarction;
- catheter ablation( cauterization of the myocardium with an electrode);
- severe and penetrating chest injuries.
In 98% of cases it is diagnosed as a post-infarction complication.
Factors that can increase the risk of pathology can be:
- Autoimmune diseases( collagenosis, vasculitis).
- Sarcoidosis( lung cancer).
- Spondylarthrosis( degenerative joint damage).
- Idiopathic( for no apparent reason) or viral pericarditis( inflammation of the outer shell of the heart).
Characteristic symptoms of Dressler's
syndrome In a stage with severe symptoms, it is difficult for a patient to perform the most basic household activities, the quality of life deteriorates very much, the recovery period after a heart attack is greatly retarded.
In periods of persistent remission, the capacity to work is restored as much as the severity of the heart attack allows.
Symptoms largely depend on where the autoimmune inflammatory process is located.
|General Symptoms|| Increased temperature( 37 to 39 ° C) |
Aseptic inflammation of the serous membranes( outer connective tissue cladding)
General weakness, poor health
Change in the blood formula( eosinophilia, leukocytosis)
|With pericardial|| Chest pain increases with strong inspiration, passes in sitting position( tilt forward) |
Elevated( 39 ° C) or low-grade fever( 37 ° C), dyspnea, swelling of the cervical veins, possible accumulation of fluidbones in the pericardial cavity( serosa of the heart)
|Pleuritis||Chest pain localized to the left and behind, dry cough( which often occurs after 3-4 days), high temperature|
|With pneumonitis||"Spilled" chest pain, fever(temperature fluctuations from 37 to 38 ° C), dry debilitating cough( sometimes with blood veins), shortness of breath after any physical effort|
|For arthritis of the shoulder joint( "hand and shoulder syndrome")|| Fever( temperature drops from 37 to 39 ° C), pain, impaired sensitivity, swollen(left or both), swelling of the fingers or hands |
Pale, cyanotic skin of the affected arm
|Skin manifestations( Dressler's syndrome, atypical form)|| Skin rash in the form of urticaria, dermatitis, erythema |
Itching surface, shallowrash, increased local temperature, bright red spots
There is no fever and no pain, there are characteristic changes in the blood formula( eosinophilia, leukocytosis)
|With perichondritis and periostitis( inflammation of the periosteum and perichondrium withstiff joints) of the anterior thoracic wall|| Swelling and pain in the sternoclavicular junction that increases after pressing |
Other characteristic symptoms( fever, changes in the blood formula) are absent
Rarely occurring forms of the Dressler syndrome - peritonitis, vasculitis( inflammation of the vascular walls), synovitisinflammation of the inner joint capsule) - are characterized by the same symptoms as other processes( fever, pain depending on the localization of the process, deterioration of well-being, change in the formmules of blood).
Potential complications of
Very rarely, post-infarction Dressler's syndrome( 1-2% of the total number of cases) is joined by its own complications:
|Name complications||His definition|
|Cardiac tamponade||cardiac dysfunction due to accumulation of fluid in the pericardial cavity|
|Hemorrhagic pericarditis||accumulation of blood in the pericardium|
|combinations of various forms of the syndrome Dressler||Pericarditis and skin reaction|
|Glomerulonephritis||severe kidney problem|
|Adhesive pericarditis||Pericardial adhesion, formation of adhesions, scars|
|Constrictive pericarditis||Thickening of pericardial walls|
|Hemorrhagic vasculature||Inflammation of vascular walls with external hemorrhages, the formation of blood clots|
|Acute hepatitis||Aseptic liver inflammation|
Complications greatly delay the recovery period, fraught with irreversible organ failure( heart failure after adhesive pericarditis), impair quality of life and affect a patient's ability to work after recovery( dyspneaafter a physical exercise).
In single cases, when a combination of many complications( for example, glomerulonephritis, pericarditis, pleurisy, hemorrhagic vasculitis) or in time not diagnosed cardiac tamponade, a fatal outcome is possible.
The disease is completely cured only in 15% of cases. In the remaining 85% - pathology acquires a chronic, often recurrent nature.
When a post-infarction Dressel's syndrome( early or late) occurs, the patient is hospitalized with such indications:
- fever and skin allergy of unknown origin in people who have recently had myocardial infarction;
- severe recurrence of postinfarction syndrome Dressler;
- unsuccessful therapy of exacerbations;
- generalization( distribution) of typical manifestations.
For treatment appoint a complex of drugs, based on hormonal drugs( glucocorticoids) and anti-inflammatory non-steroid agents. With complicated conditions( cardiac tamponade, adhesive pericarditis), surgical methods of treatment are used.
Dressler's syndrome is eliminated by hormone therapy in conjunction with drugs that remove the underlying comorbid symptoms.
|The name of the group||The name of the drug||The action they have|
|Glucocorticoids||Dexamethasone, prednisolone||Have the strongest anti-inflammatory and antiallergic effect, inhibit the accumulation of immune antibodies, the production of aggressive cell enzymes and cell destruction|
|Non-steroidal anti-inflammatory drugs( NSAIDs)||Ibuprofen, diclofenac, Aspirin||Possess a strong antipyretic, anti-inflammatory, analgesic effect. They are used to relieve the most severe symptoms of the disease( fever, pain).|
|Tropolone alkaloid||Colchicine||Has a strong anti-inflammatory effect, reduces the number of enzymes that can cause lysis( dissolution) of cellular elements in the area of the inflammatory process. It is used for negative individual reaction of the body to NSAIDs and glucocorticoids.|
|Antibiotics||Clarithromycin, azithromycin||Used in the diagnostic phase to distinguish infectious inflammation from aseptic. With Dressler's syndrome, they are ineffective|
|Gastroprotectors||Omega, Venter, De-Nol||Drugs are prescribed to protect the gastrointestinal mucosa against the background of prolonged use of hormones and NSAIDs|
Corticotropic hormones are prescribed for a period of 6 to 8 weeks, and then gradually canceled. Their long-term use can lead to complications in the form of vascular aneurysms, ulceration of the gastrointestinal mucosa, rupture of the myocardium( thinning scars).
With persistent, often relapsing form of the disease, hormonal drugs are taken continuously, throughout life( under the supervision of a doctor).
Surgical methods are used in the complication of Dressler's syndrome( constrictive pericarditis, cardiac tamponade).
|Method name||How is||performed Purpose of treatment|
|Pericardectomy||Applied with constrictive pericarditis. Partial or complete and removal of the pericardial membrane by excision||is prevented. Prevent cardiac compression and disruption of its function.|
|Pericardiocentesis||Applied with cardiac tamponade. Puncture of the chest and the introduction of anesthetic are carried out with a long thin needle, draining the fluid - with a special device or syringe. Place the puncture dilated for the catheter, through which the liquid is diverted until the||disappears. Remove blood, lymph, pus, other liquids from the pericardial cavity to improve cardiac function and relieve pericardial pressure.|
|Medical puncture||Used for fluid accumulation in the pericardium, pleural cavity. Puncture of the thoracic wall is carried out with a thin long needle, draining the fluid - with a disposable syringe, Janet or a special device. Cavities are washed and medications are administered||Remove fluid, relieve symptoms of pericarditis and pleurisy|
Dressler's syndrome is treated with surgical methods only in extreme cases - after development of especially severe complications.
Syndrome as a post-infarct complication occurs quite rarely - in 4% of cases( according to some sources up to 23%, including all atypical forms).
The treatment period for the acute period of Dressler's syndrome is from 6 to 8 weeks. In 15% of patients, the pathology is never repeated.
85% of patients face another form of autoimmune pathology - periodic exacerbations. At rare relapses the person is compelled to accept repeated treatment by courses in the acute periods( from 6 till 8 weeks), up to the end of a life.
Often the relapsing form( about 10%) will have to be treated, taking medication without interruption, until the end of life.
Even in the case of a serious, complicated, Dressler syndrome, the patient has a good prognosis for a complete recovery. In the medical literature, isolated cases with a fatal outcome( with cardiac tamponade, combining the forms of Dressler's syndrome) are described.