Postmyocardial Infarction Syndrome (Dressler's Syndrome)

Dressler's syndrome typically occurs between 2 and 12 weeks after the initial event and may follow either
ST-segment elevation or nonST-segment elevation MI (although it is rare following the latter). The overall
frequency of Dressler's syndrome has diminished substantially with the advent of reperfusion therapy.
The clinical features of Dressler's syndrome are fever, pleuritic chest pain, and polyserositis. Pleural and
pericardial friction rubs, lasting from several days to weeks, can be appreciated. Pericardial and pleural
effusions are present in most patients and, although they are typically small, large hemorrhagic effusions
have been described. Dressler's syndrome is an immune-mediated phenomenon.

Management
The pharmacologic approach to Dressler's syndrome is similar to that of early postinfarction pericarditis;
however, a course of oral corticosteroid therapy more often is needed for complete symptom relief.
Nevertheless, treatment should begin with aspirin or nonsteroidal antiinflammatory agents and, if steroids
are used, they should be gradually tapered over 1 to 4 weeks. Unfortunately, recurrences are common,
often requiring reinstitution of corticosteroids with a more gradual tapering. Drainage procedures may be
necessary for large pleural effusions that compromise overall pulmonary performance.