SHM Converge Scientific Abstract ePoster Gallery-Post-Infarction Pericarditis in the Era of Reperfusion: A Case of Dressler Syndrome

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A 62-year-old man presented with 4–5 days of dizziness, sharp pleuritic chest pain, and worsening cough, and was found to be hypotensive. His history included hypertension, prior strokes, tobacco use, and major trauma. Exam showed muffled heart sounds without clear signs of volume overload. Labs revealed elevated troponins, markedly elevated CRP, mild leukocytosis, and a negative viral panel. EKG showed inferior ischemic T-wave abnormalities, and CT angiography demonstrated a new moderate right pericardial effusion.<br /><br />Echocardiography showed a mild circumferential pericardial effusion, mildly reduced ejection fraction, severe right ventricular enlargement, and right ventricular akinesis/dyskinesis. Cardiac MRI showed no myocarditis but did reveal transmural enhancement of the left ventricular septum and right ventricular wall, supporting prior myocardial infarction with inflammatory pericardial involvement.<br /><br />The case was felt to represent Dressler syndrome, or post-myocardial infarction pericarditis, occurring 2–6 weeks after infarction and thought to result from an autoimmune response to myocardial antigens released after tissue injury. This syndrome has become less common in the reperfusion era because modern treatment limits infarct size, but it may still occur after large, sometimes silent infarcts, especially inferior infarctions with right ventricular involvement.<br /><br />Pericardiocentesis was not performed because the patient did not have tamponade, and his hypotension improved with fluids. He was treated with high-dose aspirin, colchicine, and a proton pump inhibitor, and discharged with close cardiology follow-up to evaluate the right-sided chamber abnormalities.

Asset Subtitle

Claire M. Embree

Meta Tag

Author List Claire M. Embree, Matthew Record, Nadir Bhuiyan

Category Clinical Vignettes

Concept Dressler Syndrome

Concept Myocardial Infarction

Concept Pericarditis

Concept High-Dose Aspirin

Concept Chest Pain

Distinguished Non-Finalist

Presenter Organization Mayo Clinic

Presenting Author Claire M. Embree

Track Adult

Keywords

Dressler syndrome

post-myocardial infarction pericarditis

pericardial effusion

right ventricular infarction

cardiac MRI

troponin elevation

pleuritic chest pain

hypotension

colchicine

high-dose aspirin

Dressler Syndrome

Myocardial Infarction

Pericarditis

High-Dose Aspirin

Chest Pain