Diagnosis

Your doctor will conduct a thorough physical examination, including listening to your heart with a stethoscope. Certain characteristic sounds can indicate that your pericardium is inflamed or that fluid has accumulated around your heart.

Your doctor might then recommend tests, such as:

  • Echocardiogram. Sound waves produce an image of your heart, helping your doctor to see if fluid is collecting around it.
  • Electrocardiogram. Electrical impulses in your heart are recorded through wires attached to your skin. Certain changes in the electrical impulses can indicate pressure on your heart. But electrocardiogram readings may be abnormal after heart surgery, so your doctor likely won't rely on this one test for a diagnosis of Dressler's syndrome.
  • Chest X-ray. An X-ray can help detect fluid building up around the heart or lungs and can help exclude other causes of your symptoms, such as pneumonia.
  • Blood tests. The results of certain tests can indicate inflammatory activity that's consistent with Dressler's syndrome.

Treatment

The goals are to manage pain and reduce inflammation. Your doctor might recommend over-the-counter medications, such as:

  • Aspirin
  • Ibuprofen (Advil, Motrin IB, others)
  • Naproxen (Aleve)

If those medications don't help, your doctor might prescribe:

  • Colchicine. This anti-inflammatory medication might be used, along with over-the-counter medications, to treat Dressler's syndrome. Some studies suggest that colchicine taken before cardiac surgery might help prevent postpericardiotomy. The effectiveness of colchicine for treating existing post-cardiac injury syndrome isn't clear.
  • Corticosteroids. These immune-system suppressants can reduce inflammation related to Dressler's syndrome. Corticosteroids can have serious side effects and might interfere with the healing of damaged heart tissue after a heart attack or surgery. For those reasons, corticosteroids are generally used only when other treatments don't work.

Treating complications

Complications of Dressler's syndrome can require more-invasive treatments, including:

  • Draining excess fluids. If you develop cardiac tamponade, your doctor will likely recommend a procedure (pericardiocentesis) in which a needle or small tube (catheter) is used to remove the excess fluid. The procedure is usually done using a local anesthetic.
  • Removing the pericardium. If you develop constrictive pericarditis, you might need surgery to remove the pericardium (pericardiectomy).

Some research indicates that younger people and people who have symptoms of constrictive pericarditis soon after surgery are more likely to need invasive treatments for complications of Dressler's syndrome.

Preparing for your appointment

If you're being seen in the emergency room for chest pain, you might be asked:

  • When did your symptoms begin?
  • Can you rate the severity of your chest pain, such as on a scale of 1 to 10?
  • Does anything worsen symptoms? For example, does it hurt more when you inhale deeply?
  • Where is the pain located? Does it extend anywhere beyond your chest?
  • Have you experienced a recent event that could cause tissue damage to the heart, such as a heart attack, heart surgery or blunt trauma to your chest?
  • Do you have a history of heart disease?
  • What prescription or over-the-counter medications are you taking?
July 09, 2015
References
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  2. Hoit BD. Post-cardiac injury syndromes. http://www.uptodate.com/home. Accessed May 27, 2015.
  3. Hoit BD. Etiology of pericardial diasease. http://www.uptodate.com/home. Accessed May 27, 2015.
  4. Bonow RO, et al. Pericardial diseases. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2015. http://www.clinicalkey.com. Accessed May 27, 2015.
  5. Adams JG. Pericarditis, pericardial tamponade, and myocarditis. In: Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed May 27, 2015.
  6. Imazio M, et al. Postpericardiotomy syndrome: A proposal for diagnostic criteria. Journal of Cardiovascular Medicine. 2013:14:351.
  7. Alraies MC, et al. Clinical features associated with adverse events in patients with post-percariotomy syndrome following cardiac surgery. American Journal of Cardiology. 2014;114:1426.
  8. Cantinotti M, et al. Controversies in the prophylaxis and treatment of postsurgical pericardial syndromes: A critical review with a special emphasis on paediatric age. Journal of Cardiovascular Medicine. 2014;15:847.
  9. Imazio M, et al. Cochicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: The COPPS-2 randomized clinical trial. JAMA. 2014;312:1016.