An atipic case of Dressler syndrome

Introduction: Dressler syndrome is a form of secon-dary pericarditis with or without a pericardial effusion, that occurs as a result of injury to the heart or pericar-dium. The exact cause is not known, though it is pre-sumed that an initial injury to mesothelial pericardi-al cells combined with blood in the pericardial space triggers an immune response and results in immune complex deposition in the pericardium.

Methods: We present the case of a diabetic patient, former smoker, who has arrived in the emergency ser-vice with signs of left ventricular failure phenomena; affirmatively, 48 hours before he experienced chest pain. Following the paraclinical investigations, the di-agnosis of inferior-lateral myocardial infarction was established. A coronarography was performed, which revealed occlusion in the middle segment of the cir-cumferential artery without visualization of the distal territory, opting for conservative treatment and revas-cularization after 3 weeks. During hospitalization the patient presented a tremendous evolution, maintaining the phenomena of mild left ventricular insufficiency, electrocardiographic with the presence of Q wave in the inferior territory and echocardiography with infe-rior and lateral wall hypokinesia, ejection fraction of 35-40%, without pericardial fluid. The patient returned after 2 days of discharge with large amounts of pericardial fluid.

Results: T he diagnosis of Dressler syndrome has been established, the case particularity being the lar-ge amount of pericardial fluid installed in a very short time (2 days) in context of an oligosymptomatic patient. Anti-inflammatory therapy with Aspirin and Colchici-ne was started with favorable evolution and reducing the quantity of fluid by half within a week. But in an attempt to reduce the doses of Aspirin, the pericardial fluid increased rapidly, even higher, the ultrasound ex-hibiting signs of right ventricular collapse, the patient being still oligosymptomatic. After resuming the high doses of Aspirin, the fluid has begun again to remit.

Conclusions: In percutaneous coronary intervention era, Dressler syndrome became a rarity. It’s presence requires careful and long-term monitoring. Our pati-ent is an example of Dressler syndrome with an atypical debut and evolution, which under optimal drug thera-py finally showed a favorable resolution.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)