Dressler's syndrome in cardiology is pericarditis of an autoimmune nature of origin, which develops a few weeks after myocardial infarction in an acute form. This complication is characterized by the traditional triad of symptoms: chest pain, pulmonary manifestations (cough, wheezing, shortness of breath), rubbing noise between the sheets of the pericardium.
Dressler's syndrome in cardiology (or post-infarction syndrome) is an autoimmune damage to the tissues of the pericardial sac. This is a complication that is caused by an inadequate immune response to destructive changes in myocardial proteins. This pathological process was described by a cardiologist from the USA W. Dressler in 1955. In his honor, the disease received its second name. In addition, in the medical literature you can find such terms as: post-infarction polyserositis, late pericarditis, post-traumatic, post-cardiotomy and pericardial syndrome. In general, the prevalence of this complication of infarction is 3-4%. However, according to information from various sources,taking into account the asymptomatic and atypical forms, this complication develops in approximately 15-30% of patients who have suffered repeated, complicated or extensive myocardial infarction.
Reasons
The initial cause of Dressler's syndrome in cardiology is an ischemic lesion of the structural fibers of the heart muscle, which leads to the death of cardiomyocytes. In most cases, it develops with a complicated macrofocal infarction. During the destruction of necrotic tissue, denatured proteins begin to enter the bloodstream. The immune system, in turn, reacts to them as if they were foreign. As a result, an autoimmune reaction occurs, which is the cause of the development of post-infarction syndrome.
The blood antigens that penetrate into the pericardium in the process of myocardial integrity are of particular importance in the formation of the symptom complex of this complication of a heart attack. Therefore, in addition to the acute stage, the trigger for the formation of the disease can be hemopericardium, characterized by hemorrhage into the pericardial cavity. In addition, this condition may be due to chest trauma, heart injury, or inadequate cardiac surgery. Also at risk are post-infarction patients with autoimmune pathologies. Some doctors believe that a viral infection is the cause of the development of the inflammatory process. However, cardiologists do not yet have a clear answer on this issue.
Pathogenesis
SyndromeDressler in cardiology is an autoimmune process that develops as a result of the intensification of the production of antibodies to cardiac antigens. In this case, an acute violation of the processes of blood supply to the myocardium and the death of its cells entails the resorption of necrosis zones and the release of denatured components into the bloodstream. This contributes to the development of an immune response with the formation of autoantibodies, the action of which is directed against proteins present in the composition of the serous integument of target organs.
Immune antibodies to cardiomyocytes, which are present in large quantities in the plasma of postinfarction patients, form immune complexes with the content of cells of their own tissues. They circulate freely in the bloodstream, accumulate in the visceral, pericardial pleura and in the internal structures of the articular capsules, provoking an aseptic inflammatory process. In addition to this, the level of cytotoxic lymphocytes begins to rise, which destroy damaged cells in the body. Thus, the state of both humoral and cellular immunity is significantly disturbed, which confirms the autoimmune nature of the symptom complex.
Varieties
Dressler's syndrome after myocardial infarction - what is it? This disease is divided into 3 forms. Within each of them there are also several subspecies, the classification of which is based on the localization of inflammation. So, Dressler's syndrome happens:
1. Typical. The clinical manifestations of this form are associated with inflammation of the visceral pleura, pericardium and pulmonaryfabrics. It includes combined and single variants of autoimmune damage to connective tissues:
- pericardial - the parietal and visceral layers of the pericardial sac become inflamed;
- pneumonic - infiltrative disorders are formed in the lungs, leading to pneumonitis;
- pleural - the pleura becomes the target of antibodies, signs of hydrothorax develop;
- pericardial-pleural - there are symptoms of sensitization of the pleura and serosa of the pericardium;
- pericardial-pneumonic - the pericardial membrane and lung tissues are affected;
- pleural-pericardial-pneumonic - inflammation passes from the heart bag to the pulmonary and pleural structures.
2. Atypical. This form is characterized by variants due to the defeat of antibodies in the joints and vascular tissues. It is accompanied by an inflammatory process in large articular joints or skin reactions: pectalgia, "shoulder syndrome", erythema nodosum, dermatitis.
3. Asymptomatic (erased). With this form, with mild symptoms, there is a fever, persistent arthralgia and a change in the composition of white blood.
When diagnosing atypical and erased forms of the syndrome, some difficulties often arise, which make the most in-depth study of this disease relevant.
Symptoms
Classic Dressler syndrome develops approximately 2-4 weeks after a heart attack. To the most commonsymptoms include heaviness and pain in the chest, fever, cough, shortness of breath. The pathological process in most cases begins acutely, with an increase in temperature to febrile or subfebrile levels. Dizziness, weakness, nausea appear, breathing and pulse quicken.
Pericarditis is an obligatory element of the symptom complex. For him, pain sensations of different intensity in the heart zone are typical, extending to the abdomen, neck, shoulders, shoulder blades and both arms. The pain may be sharp, paroxysmal, or dull, squeezing. When swallowing and coughing, tightness in the chest is noted, the pain intensifies. In the position lying on the stomach or standing, it weakens. Palpitations, shortness of breath, frequent shallow breathing are often observed. In 85% of patients, there is a friction rub of the pericardial sheets. After a few days, the pain subsides. A characteristic manifestation of pleurisy is a unilateral stabbing pain in the upper torso, which intensifies with a deep breath and tilt to the he althy side.
For pneumonitis typically hard weakened breathing, wheezing, shortness of breath, cough. Rarely develops lower lobe pneumonia. The disease is accompanied by weakness, excessive sweating and febrile syndrome. Blood impurities may appear in the sputum. In atypical forms of the disease, the functions of the joints are disturbed.
Pericarditis and Dressler's syndrome
Pericarditis is an inflammation of the pericardial sac of a rheumatic, infectious or postinfarction nature. Pathology is manifested by weakness, pain behind the sternum, whichaggravated by inhalation and coughing. Bed rest is required to treat pericarditis. In the case of a chronic form of the disease, the regimen is determined by the patient's condition. In acute fibrinous pericarditis, symptomatic treatment is prescribed: anti-inflammatory nonsteroidal drugs, analgesics to eliminate pain, drugs that normalize metabolic processes in the heart muscle, and more. In Dressler's syndrome, pericarditis is treated with drugs that eliminate the underlying disease.
Abdominal localization of the syndrome
Pathology is determined by peritonitis, an inflammatory process in the inner lining of the cavity. Has a vivid clinical picture:
- intense, excruciating pain in the abdomen. The strength of painful sensations decreases when finding a comfortable body position - most often lying on your side with bent legs;
- stool disorders;
- pronounced increase in temperature.
With the development of this form of the syndrome, it is urgent to differentiate the autoimmune form from the infectious one, which is often the result of pathologies of the digestive tract. Treatment tactics depend on the results of timely diagnosis, which most often involves the use of various groups of medicines.
Diagnosis of pathology
We continue to describe Dressler's syndrome after myocardial infarction. What it is is now clear. However, the situation is described only in the general case, it is better for each specific person to consult with their doctor. When diagnosing this complication of a heart attack, the patient's complaints, characteristicclinical symptoms and results of a comprehensive instrumental and laboratory examination. Valuable diagnostic parameters that give a complete picture of the patient's condition include:
- Clinical criteria. Signs that confirm a high likelihood of developing Dressler's polyserositis are febrile fever and pericarditis.
- Laboratory research. In the KLA are possible: eosinophilia, leukocytosis, increased ESR. In addition, a blood test is carried out for markers of damage to the heart muscle. An increase in the level of globular proteins - troponin T and troponin I - confirms the fact of cell death.
- In the diagnosis of Dressler's syndrome, an ECG is often used, which shows a negative trend. The most typical sign is unidirectional movement of the ST segment in several leads.
- Ultrasound of the pericardium and pleural cavities.
- Chest x-ray. With the development of pleurisy, the interlobar pleura thickens, with pericarditis, the cardiac shadow expands, with pneumonitis, darkening in the lungs is determined. In some cases, cardiomegaly is clearly visible in Dressler's syndrome after a heart attack.
- In unclear diagnostic situations, an MRI of the lungs and heart is prescribed.
Treatment of this disease
Treatment takes place in stationary conditions. Emergency care for Dressler's syndrome is usually not required, since there is no clear threat to life. However, if treatment is started sooner, the chances of recovery are greatly increased.
Mainrole in the spectrum of therapeutic measures in postinfarction Dressler's syndrome is played by drug therapy, which has several goals and involves the use of multidirectional drugs:
- Cardiotropic, which help to eliminate cardiac disorders. These are medicines used in the treatment of coronary artery disease: beta-blockers, antianginal drugs, nitrates, calcium channel blockers, cardiac glycosides.
- Anti-inflammatory. In case of resistance to NVPS, short courses of glucocorticoid administration are carried out. In severe forms of the disease, drugs of other groups are used ("Methotrexate", "Colchicine").
Anticoagulants due to the increased likelihood of developing hemopericardium in the treatment after a heart attack are not used. If necessary, their use is prescribed subtherapeutic dosages. In each case, the treatment of this pathology is selected individually. With severe pain syndrome, intramuscular administration of analgesics is indicated. With a significant accumulation of effusion, a puncture of the pericardial cavity or pleurocentesis is performed. With cardiac tamponade, a surgical intervention is performed - pericardiectomy.
How to prevent the development of Dressler's syndrome?
This syndrome is not considered a life-threatening condition, even with the most severe course, the prognosis for the patient is relatively favorable. Methods of primary prevention, which is aimed at eliminating the causes of the development of Dressler's syndrome, todaynot yet developed. However, to reduce the likelihood of articular manifestations in patients who have had an acute infarction, early activation is recommended. In pathologies with a relapsing course, anti-relapse therapy is prescribed to prevent a re-exacerbation of the pathological process.
Clinical Guidelines for Dressler Syndrome
In order to reduce the risk of developing this disease, it is necessary to carefully consider all the emerging symptoms associated with heart disease. Since the initial cause of the development of Dressler's syndrome is myocardial infarction, preventive measures should primarily be aimed at preventing the development of this acute condition. The main clinical recommendation is timely observation by a cardiologist, taking anti-ischemic, anti-thrombotic drugs, as well as drugs to reduce high cholesterol.
Complications of this pathology
In the absence of high-quality and timely diagnosis and medical care, Dressler's syndrome can lead to the development of constructive or hemorrhagic pericarditis (the appearance of bloody exudate or squeezing of the heart tissue), and in more advanced cases, it causes serious cardiac tamponade. This pathology is characterized by a relapsing course with remissions and exacerbations occurring at intervals of 1-2 weeks to 2 months. Under the influence of therapy, there is a weakening of symptoms, and in the absence of correctiondisease, as a rule, attacks with renewed vigor.
