Persistent ST Segment Elevation After Repeated Percutaneous Coronary Intervention: A Dressler Syndrome?

In the era of percutaneous coronary intervention (PCI), Dressler syndrome has become an extremely rare phenomenon. Originally known as post-myocardial infarction syndrome, it is characterized by fever, pleuritic chest pain, and pericardial or pleural effusion after myocardial infarction. It is one of the sub-entities of post-myocardial infarction pericarditis (PMIP). A 62-year-old man presented with persistent chest pain and diffuse ST segment elevation even after repeated PCIs. This condition was accompanied by fever and bilateral pleural effusion upon chest X-ray. The patient showed improvement in ST segment elevation and clinical condition after 2 weeks of steroid administration. The findings in this case suggest the possibility of PMIP. Although uncommon, physicians should be aware of the potentials of this condition in the differential diagnosis of chest pain after myocardial infarction and PCI so that immediate effective treatment can be given.

Post-cardiac injury syndrome: an atypical case following percutaneous coronary intervention.

Post-cardiac injury syndrome (PCIS) is a syndrome characterized by pericardial and/or pleural effusion, triggered by a cardiac injury, usually a myocardial infarction or cardiac surgery, rarely a minor cardiovascular percutaneous procedure. Nowadays, the post-cardiac injury syndrome, is regaining importance and interest as an emerging cause of pericarditis, especially in developed countries, due to a great and continuous increase in the number and complexity of percutaneous cardiologic procedures. The etiopathogenesis seems mediated by the immunitary system producing immune complexes, which deposit in the pericardium and pleura and trigger an inflammatory response. We present the atypical case of a 76-year-old man presenting with a hydro-pneumothorax, low-grade fever and elevated inflammation markers, after two complex percutaneous coronary interventions, executed 30 and 75 days prior. The clinical features of our case are consistent with the diagnostic criteria of PCIS: prior injury of the pericardium and/or myocardium, fever, leucocytosis, elevated inflammatory markers, remarkable steroid responsiveness and latency period. Only one element does not fit with this diagnosis and does not find any further explanation: the air accompanying the pleural effusion, determining a hydro-pneumothorax and requiring a pleural drainage catheter positioning.

Acute Pericarditis Following Acute Pulmonary Thromboembolism.

We describe the case of a 45-year-old Japanese man who developed acute pericarditis following an acute pulmonary thromboembolism. He had developed shortness of breath 7 days prior to hospitalization and was admitted with severe dyspnea. Echocardiography and laboratory results were compatible with acute pulmonary thromboembolism, which was confirmed by contrast-enhanced chest computed tomography. On the third hospital day, he experienced chest pain exacerbated by inspiration. On the fourth hospital day, his body temperature increased to 39°C and echocardiography revealed circumferential pericardial effusion. A diagnosis of acute pericarditis was made and the patient was treated with colchicine and aspirin. On the fifth hospital day, his symptoms largely subsided. Auscultation revealed pericardial friction rub. Electrocardiography demonstrated diffuse ST-segment elevations. Twenty-four days later, computed tomography revealed the disappearance of both the pericardial effusion and pulmonary arterial emboli. This case was thought to be one of acute pericarditis following acute pulmonary thromboembolism.

Post-cardiac Injury Syndrome Following Catheter Ablation of Atrial Flutter: A Case Report.

A woman in her 70s presented to accident and emergency (A&E) with shortness of breath and fever following atrial flutter ablation. Initial investigations revealed a new onset of pleural and pericardial effusion with raised inflammatory markers. After systematically ruling out chest infection and heart failure, a diagnosis of post-cardiac injury syndrome (PCIS) was made. After a short course of steroids and colchicine, she showed significant improvement in her symptoms, and subsequent follow-up showed resolution of her pleural and pericardial effusion.

Coronary Sinus Thrombosis and Post-Myocardial Infarction Syndrome in Kawasaki Disease: Rare Causes of Pericardial Effusion.

The hypercoagulable state in Kawasaki disease (KD) may lead to complex cardiovascular sequelae. We present the case of a 2-month-old infant with complete KD complicated by giant coronary artery aneurysms, coronary sinus thrombosis, and post-myocardial infarction syndrome (Dressler syndrome), resulting in 2 distinct episodes of pericardial effusion. (Level of Difficulty: Intermediate.).

Dressler Syndrome: Not Just a Relic of the Past.

Dressler syndrome, also known as post-myocardial infarction syndrome, is a condition in which sterile pericarditis develops shortly after myocardial injury. It is characterized by pericardial inflammation typically including pericardial effusion, pleuritic chest pain, and elevated inflammatory markers. While its incidence has greatly decreased in the modern era of coronary revascularization, it remains a clinically important entity with the potential for serious morbidity. Here we present a case of presumed Dressler syndrome in a 54-year-old male who presented to the emergency room with a recurrence of chest pain and clinical signs of pericarditis after sustaining an anterior myocardial infarction two weeks previously.

Post-cardiac Injury Syndrome Following Permanent Dual-Chamber Pacemaker Implantation.

Post-cardiac injury syndrome is a heterogeneous group of conditions that result from autoimmune-mediated inflammation of the pericardium, epicardium, and myocardium. Interventions such as pacemaker lead insertions, percutaneous coronary interventions, radiofrequency ablations, cardiac surgeries, and Swan-Ganz catheterizations can cause myocardial injury leading to post-traumatic pericarditis. This phenomenon can lead to chest pain, recurrent effusions, and fever along with possible complications of heart failure, arrhythmias, conduction abnormalities as well as cardiac tamponade. Herein, we present a case report of a 64-year-old female with a history of sick sinus syndrome managed with a dual-chamber pacemaker who presented with post-cardiac injury syndrome after three months of pacemaker implantation. She developed a recurrent syndrome of fever, chest discomfort, tachycardia with weakness, hemodynamic instability, hemorrhagic serositis, and cardiac tamponade. The mechanism of exudative inflammatory effusions initially remained inconclusive, as the workup for infectious and malignant processes was negative. However, post-cardiac injury syndrome akin to the Dressler syndrome related to screw-in dual-chamber pacemaker implantation remained a possibility. Her condition was acutely managed with a combination of colchicine and glucocorticoid therapy. She was placed on long-term aspirin and colchicine therapy to prevent any recurrences. This article illustrates a case of post-cardiac injury syndrome after dual-chamber pacemaker implantation, including details of evaluation, management, complications and monitoring of patient progress.

A case of Dressler's syndrome successfully treated with colchicine and acetaminophen.

The incidence of Dressler's syndrome after myocardial infarction (MI) has decreased in the reperfusion therapy era. Although guidelines recommend high-dose aspirin for treatment based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era, bleeding and thrombotic concerns occurred upon aspirin administration after coronary stenting. A 69-year-old man with recent MI was admitted to our hospital. The patient presented with chest pain 1 week before admission. Electrocardiography revealed newly detected atrial fibrillation with no ST segment change. Urgent coronary angiography demonstrated a left circumflex artery occlusion. He underwent PCI, and a sirolimus-eluting stent was deployed. Aspirin, prasugrel, and apixaban were administered. However, hospital discharge was delayed because he developed heart failure during hospitalization. Twenty-three days after admission, he developed a fever of >39 °C. Electrocardiography showed anterior ST segment elevation, and echocardiography revealed a 6-mm pericardial effusion. We diagnosed the patient with Dressler's syndrome, and colchicine 0.5 mg/day + acetaminophen 2000 mg/day were administered. His condition clinically improved after treatment and he was discharged 32 days after admission. There was hesitation about administration of high-dose aspirin in a patient who has undergone recent coronary stenting. Combination therapy of colchicine and acetaminophen could be a treatment option for Dressler's syndrome. .

Shockwave cardiac injury in thoracoabdominal gunshot wound.

INTRODUCTION AND IMPORTANCE: Cardiac injuries are associated with high mortality rates and most affected individuals succumb to their injuries before arrival to the hospital. Even though they have a higher fatality rate, penetrating cardiac injuries are relatively easy to diagnose and they have straightforward management protocols. On the other hand unexpected non-penetrating cardiac injuries, especially in haemodynamically stable patients, are not looked out for and can be difficult to diagnose. They may have a delayed presentation leading to poor patient outcomes. Clinicians should have a high index of suspicion when wound paths are in the vicinity of the heart, to avoid missing early signs and possibly prevent late presentation of these injuries. CASE PRESENTATION: Two previously well male patients aged 29 and 33 years old respectively, sustained gunshot wounds to the thoracoabdomen which in each case became associated with non perforating cardiac injuries. The first case highlighted the unfortunate end of these uncommon injuries when there are other serious injuries present. The second case illustrated possibility of late complications even after management of non-penetrating cardiac injury. CLINICAL DISCUSSION: In these cases, shock wave injury refers to non penetrating cardiac injury induced by high a voltage bullet in proximity to the heart/pericardium. A thorough history and examination in addition to multiple investigational modalities should be performed in order to exclude cardiac shockwave injuries. In some instances serial imaging studies are needed to detect the earliest changes associated with these injuries. CONCLUSION: Cardiac injuries carry a high morbidity and mortality and therefore a timeous diagnosis and management of these injuries is essential to prevent fatalities.

Síndrome de Dressler: el retorno de una enfermedad olvidada / Dressler's syndrome: the return of a forgotten entity

Resumen El síndrome de Dressler es una enfermedad infrecuente que fue descrita por primera vez en 1956 por el doctor William Dressler. Corresponde a un cuadro de pericarditis secundaria, en ocasiones asociada a efusión pericárdica de aparente etiología autoinmunitaria, que hace parte de los síndromes de lesión poscardiaca. Se presenta un caso de síndrome de Dressler en un paciente joven.

Abstract Dressler's syndrome is a rare entity which was first described in 1956 by Dr. William Dressler. It consists of secondary pericarditis, at times associated with pericardial effusion with an apparently autoimmune etiology, which is one of the post-cardiac injury syndromes. We present a case of Dressler's syndrome in a young patient.

A life-saving case of Dressler's syndrome.

Myocardial rupture is an uncommon and life threatening event which may occur in the setting of acute myocardial infarction. In this case report we describe a rare instance of a patient presenting with signs of ventricular rupture as a late presentation of myocardial infarction. The findings of cardiac computed tomography are demonstrated as well as intra-operative images. Despite its very high attendant mortality risk, our patient's life was saved by the earlier development of Dressler's syndrome, an intense inflammatory process in the pericardium, resulting in dense adhesions, which effectively tamponaded the leak from the ventricular free wall rupture and prevented extravasation.