Dressler's syndrome ( Dressler syndrome ) - Causes, Symptoms and Treatment .MF .
Symptoms Diagnosis Treatment
Lifestyle, complications and prognosis
Myocardial infarction is dangerous not only because it causes a significant impairment of the function of the cardiovascular system, but also because it can lead to the development of complications.One of them is Dressler's syndrome, or Dressler syndrome.
Dressler's syndrome - an autoimmune connective tissue damage in a patient who had undergone an extensive myocardial infarction.Manifested fever, lesions of the pericardium, pleura, lung tissue and joint membranes.It develops in 4% of all cases for 10 - 14 days after the onset of heart attack.The danger of this syndrome is that it can occur for a long time, with periodic exacerbations and remissions, disrupting the quality of life and well-being of the patient.
are the following forms of the syndrome:
1. A typical form is characterized by various combinations of damage connective tissue:
- pericardial option
- pleural, pericardial-pnevmonichesky
2. Atypical forms manifested cardio-shoulder, arthritic, cutaneous, peritoneal options.
3. malosimptomno (erased) form appears low-grade fever, joint pain, and changes in general blood test.
reasons Dressler syndrome
main cause of the disease is the damage and death (necrosis) of heart muscle cells in acute myocardial infarction, the yield degradation products in blood and autoserotherapy (increased immune sensitivity, aimed at its own tissues) of the body to the denatured proteins of dead cells.Aggression occurs immune cells responsible for recognition of antigens (foreign substances), but in this case the reaction is directed against the protein molecules, located on cell membranes lining the heart, lung and joints - pericardium, pleura, and synovial (joint) membranes.The result is a cross autoimmune reaction with their own cells that the body sees as foreign.Pleura, pericardium and inflamed synovial membranes, but inflammation is aseptic nature without bacteria and viruses, and allocate a certain amount of fluid that accumulates between the sheets of pleura and pericardium, as well as in the joints, causing pain and dysfunction.
Not only macrofocal or transmural myocardial infarction may be the cause of the syndrome Dressler, but surgery on the heart.After reconstructive surgery on the mitral valve rarely develops postcommissurotomy syndrome after surgery on the heart with the dissection of the pericardium - cardiotomy syndrome.These options are similar to the post-infarction syndrome in terms of the causes, mechanisms of development, clinical manifestations and treatment, so collectively they are called Dressler's syndrome.
increases the risk of complications of existing patient systemic autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, etc.), as well as the late locomotor activation of the patient after a heart attack.
Dressler syndrome symptoms
clinical manifestations may occur in the time interval between two weeks and two months after an acute heart attack.Dressler's syndrome is manifested by such signs:
- General malaise and feeling unwell.
- Rising temperatures often occurs before subfebrile (not above 39 0 C), low-grade fever can be steadfast in the interictal period (37.3 - 38 0 C).
- Pericarditis - a mandatory feature of Dressler's syndrome.Manifested by pain in the acute heart, crushing, squeezing character, enhanced by the height of inspiration and when coughing and disappearing in the supine or sitting with a forward tilt.They can be given in the neck, shoulder and left arm.
- pneumonitis (not to be confused with pneumonia - inflammatory bacterial or viral lung lesion) develops as a result of the defeat of the interstitial lung tissue and appears diffuse chest pain on both sides, dyspnea on exertion and dry cough, sometimes streaked with blood.When the patient's complaints of shortness of breath, cough and hemoptysis doctor should think of another serious complication of a heart attack - pulmonary embolism.
- pleurisy appears superficial pain in the left side of the chest, over the side and rear and a dry cough.Pain and cough disappear on their own within two - four days.Pleurisy in combination with signs of pericarditis, and pneumonitis temperature can reliably assume a diagnosis of Dressler's syndrome.
The picture shows pleural effusion
- «chest - shoulder - arm" syndrome (kardioplechevoy syndrome) is currently being developed much less than before, which is associated with an earlier activation of patients after a heart attack.Manifested by pain in the left shoulder joint, disorders of sensation in his left hand, a sense of numbness and "pins and needles" in hands, pale skin color of the marble arm and hand.
- anterior chest wall syndrome due to the progression of osteoarthritis of the joints at the junction of the sternum and clavicle, and, most likely, is also associated with prolonged immobility of the patient with acute myocardial infarction.It causes pain and swelling in the area of the sternum and clavicle on the left.
- Cutaneous manifestations : may develop a skin rash, resembling hives, dermatitis, eczema or erythema.
In most cases there is chronic syndrome with acute exacerbations, which last from a few days up to 3 - 4 weeks and remissions lasting several months.Rarely observed single attack with a full recovery.
syndrome Diagnostics Dressler
The diagnosis may be suspected on the basis of typical complaints of the patient after suffering a heart attack in the past two months, as well as on the basis of examination of the patient data - on auscultation of the chest auscultated rubbing the pericardium and pleura, crackles in the lower lungs.More research methods can be assigned to confirm the diagnosis:
- Extended blood tests - observed increase in the number of leukocytes (more than 10 x 109 / l), accelerated erythrocyte sedimentation rate (20 mm / h), increase in the number of eosinophils (more than 5% in the leucocyte count).
- Biochemical analysis of blood, rheumatologic tests, immunological studies.Determined by elevated levels of C - reactive protein, may be increased levels of MB - fraction of creatine phosphokinase and troponin (acute myocardial markers), but not always, which requires differential diagnosis with recurrent myocardial infarction.
- ECG does not reveal any - any significant deviations, except for signs of myocardial scarring.
- Echocardiography reveals thickening of the pericardial leaflets, restricting their mobility, the presence of fluid (effusion) in the pericardial cavity.Defined area of reduced myocardial contractility (hypokinesia), indicating myocardial.
- Chest X-ray - defined thickening of interlobar pleural with pleurisy may be diffuse increased pulmonary pattern, linear or patchy darkening of the lung tissue with pneumonia, increasing the shadow of the heart in pericarditis.
- X-ray of the shoulder joint can show narrowing of the joint space, bone tissue sealing and other features previously available osteoarthritis.
- CT or MRI scans of the chest are appointed in diagnostically unclear cases to clarify the nature of pericarditis, pleurisy and pneumonitis.
Treatment syndrome Dressler
Therapy syndrome arising for the first time, should be carried out in a hospital.Subsequent recurrences can be treated on an outpatient basis at a moderate course.From
intravenous drugs in tablet form and are assigned:
- prednisolone, dexamethasone and other glucocorticoid hormones in a daily dose of 30 - 40 mg.Improving the condition it is observed on the second - the third day from the start of hormone treatment, but therapy should be long, for weeks and months, since the abolition of possible new drugs relapse.You need gradual abolition of prednisolone, with a reduction in the dosage of 5 mg per week until complete withdrawal of the drug.
- nonsteroidal antiinflammatory drugs (NSAIDs) diclofenac, indomethacin, aspirin, nimesulide, dosages are determined by the attending physician.
- antibiotics are ineffective, but may be assigned at the difficulties of the differential diagnosis of infectious pulmonary involvement, pericardial and joints.
- cardiotropic drugs for the treatment of ischemic heart disease - aspirin, bettablokatory, lipid-lowering drugs (statins), ACE inhibitors, etc.
-. Analginum dimedrolom intramuscularly at the expressed painful syndrome.
Besides drug therapy, in cases expressed pleurisy and pericarditis, effusion, accumulates in the cavities when a significant amount of fluid can be displayed pleural and pericardial effusions removing puncture.
Lifestyle syndrome Dressler
Patients with postinfarction syndrome should observe a healthy lifestyle, which is required for all patients with acute myocardial infarction.We must observe the following simple principles:
- healthy diet - eating more fresh fruits and vegetables, juices, fruit drinks, cereals and cereal products, the replacement of animal fat to vegetable.It is necessary to limit the consumption of fatty meats and poultry, eliminate coffee, sodas, fried, spicy, salty, spicy dishes and food to cook boiled or steamed.It is recommended to reduce salt intake to 5 grams per day, and the amount of fluid intake - to 1.5 liters per day;
- rejection of bad habits;
- early activation of the patient in the bed during the acute phase of myocardial and moderate physical activity in the future.Already on the second - the third day of myocardial shown breathing exercises and physiotherapy under medical supervision in a prone position in bed (with strict bed rest - movement wrists, relaxation exercises), and then sitting and standing (at the ward mode) of no more than5 - 10 minutes.Further sanatorium - resort treatment applied dosed walking, therapeutic exercises, etc.
Complications Complications of post-infarction syndrome almost do not develop, although described isolated cases of severe renal disease with the development of glomerulonephritis, and vascular lesions in the form of hemorrhagic vasculitis..Rarely, if untreated, hormonal therapy, possible outcome of pericardial effusion in adhesive pericarditis, which prevents relaxation of the heart muscle and contributes to stagnation of blood in the systemic circulation.Develops restrictive (diastolic) heart failure.
Weather favorable for life.
temporary loss of ability to work (sick leave) in complicated Dressler syndrome myocardial infarction is determined for a period of 3 - 3.5 months, according to testimony as long as possible.
permanent disability (disability) is determined by the frequency of relapses, the degree of cardio - vascular function caused by not only pleurisy, pericarditis and joint disease, but also to a myocardial infarction.Typically, Dressler's syndrome does not directly lead to disability.
therapists Sazykina OJ