Dressler's syndrome: Difference between revisions
No edit summary |
|||
| Line 38: | Line 38: | ||
==Diagnosis== | ==Diagnosis== | ||
*Need 2 of the following diagnostic criteria for acute pericarditis | |||
*Need 2 of the following | |||
**Chest pain (typically sharp and pleuritic, improved by sitting up and leaning forward) | **Chest pain (typically sharp and pleuritic, improved by sitting up and leaning forward) | ||
**Pericardial friction rub | **Pericardial friction rub | ||
**New or worsening pericardial effusion | **New or worsening pericardial effusion | ||
**Suggestive ECG changes | **Suggestive ECG changes | ||
AND | |||
*Appropriate time-frame: 1 week to approximately 3 months after myocardial infarction | *Appropriate time-frame: 1 week to approximately 3 months after myocardial infarction | ||
Revision as of 18:12, 5 March 2020
Background
Dressler's syndrome, also known as late post-MI pericarditis, is pericarditis that occurs one week to several months after a myocardial infarction. It is thought to be immunologic and is less commonly seen after PE, pericardial trauma, or pericardiectomy.[1]
Clinical Features
Signs and Symptoms
- Pleuritic chest pain
- Fever
- Malaise
- Pericardial friction rub
Findings
- EKG findings characteristic of pericarditis
- Pericardial effusion
- Pleural effusion
- Leukocytosis, elevated ESR or CRP[2]
Differential Diagnosis
ST Elevation
- Cardiac
- ST-segment elevation myocardial infarction (STEMI)
- Post-MI (ventricular aneurysm pattern)
- Previous MI with recurrent ischemia in same area
- Wellens' syndrome
- Coronary artery vasospasm (eg, Prinzmetal's angina)
- Coronary artery dissection
- Pericarditis
- Myocarditis
- Aortic dissection in to coronary
- Left ventricular aneurysm
- Left ventricular pseudoaneurysm
- Early repolarization
- Left bundle branch block
- Left ventricular hypertrophy (LVH)
- Myocardial tumor
- Myocardial trauma
- RV pacing (appears as Left bundle branch block)
- Brugada syndrome
- Takotsubo cardiomyopathy
- AVR ST elevation
- Other thoracic
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Medications
Evaluation
Diagnosis
- Need 2 of the following diagnostic criteria for acute pericarditis
- Chest pain (typically sharp and pleuritic, improved by sitting up and leaning forward)
- Pericardial friction rub
- New or worsening pericardial effusion
- Suggestive ECG changes
AND
- Appropriate time-frame: 1 week to approximately 3 months after myocardial infarction
Management
Disposition
See Also
External Links
References
- ↑ Jouriles N. Pericardial and Myocardial Disease. In: Rosen's Emergency Medicine: Concepts and Clinical Practice: Volume 1. Philadelphia: Mosby/Elsevier; 2010.
- ↑ Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol. 2013;168(2):648–652. doi:10.1016/j.ijcard.2012.09.052