Your doctor will do a thorough physical examination, including listening to your heart with a stethoscope. A specific sound, called a pericardial rub, can occur when your pericardium is inflamed or when fluid has collected around your heart.
Your doctor might then recommend tests, such as:
- Complete blood count. Most people with Dressler syndrome have an increased white blood cell (WBC) count.
- Blood tests to measure inflammation. A higher than normal level of C-reactive protein and an increased erythrocyte sedimentation rate (sed rate) can indicate inflammation that's consistent with Dressler syndrome.
- Electrocardiogram (ECG or EKG). This painless, quick test records electrical signals in your heart through wires attached to your skin. Certain changes in the electrical signals can indicate pressure on your heart. But EKG readings may be abnormal after heart surgery, so your doctor will consider results of additional tests when diagnosing Dressler syndrome.
- Chest X-ray. A chest X-ray can help detect fluid around the heart or lungs. It can also help rule out other causes of your symptoms, such as pneumonia.
- Echocardiogram. Sound waves produce an image of your heart, helping your doctor to see if fluid is collecting around it.
- Cardiac magnetic resonance imaging (MRI). A cardiac MRI uses sound waves to create still or moving pictures of how blood flows through the heart. This test can show thickening of the pericardium.
The goals of treatment for Dressler syndrome are to manage pain and reduce inflammation. Treatment may involve medications and, if complications occur, surgery.
The main treatment for Dressler syndrome is medication to reduce inflammation. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as:
- Ibuprofen (Advil, Motrin IB, others)
If Dressler syndrome occurs after a heart attack, usually aspirin is preferred over other NSAIDs.
Indomethacin may also be given.
If those medications don't help, your doctor might prescribe corticosteroids. These powerful immune system suppressants can reduce inflammation related to Dressler 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.
Complications of Dressler 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).
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 had 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?
Jan. 22, 2021
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- Bonow RO, et al., eds. Pericardial diseases. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Dec. 8, 2020.
- Walls RM, et al., eds. Pericardial and myocardial disease. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Dec. 8, 2020.
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