Dressler's syndrome
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Description:
Dressler's syndrome – one of possible complications of a myocardial infarction. The main symptom complex of a syndrome of Dressler includes a pericardis, pleurisy, pneumonia, inflammatory damages of joints, fever. In blood at Dressler's syndrome typical signs of an inflammation (increase in quantity of leukocytes and a blood sedimentation rate), and also, increase in a caption of anti-myocardial antibodies, characteristic of autoimmune reaction, are observed. Antibodies appear in response to a necrosis of a myocardium and penetration into blood of decomposition products of fabrics.
Dressler's syndrome can be registered on 2 – 6 week of a myocardial infarction, but terms of its emergence can sometimes decrease up to 1 week or stretch up to several months. The current of a syndrome sometimes accepts difficult and long character, can last within several years with periodic with remissions and aggravations.
Symptoms of the Syndrome of Dressler:
All symptoms of a syndrome of Dressler seldom appear at the same time. The main obligatory symptom is the pericardis.
At a pericardis there are pains in heart which can irradiate in a neck, the left shoulder, a shovel, an abdominal cavity. In character pains happen acute, pristupoobrazny, pressing or squeezing. Pains usually amplify for cough, swallowing or even breath, and weaken in a standing position or lying on a stomach. Pains usually long also decrease after release of inflammatory exudate in a pericardium cavity. When listening patients with a pericardis – the pericardial rub is defined. Noise also decreases after emergence of liquid in a pericardium cavity. Current of a pericardis in most cases not heavy. Pains abate within several days, and the quantity of the exudate pericardium which accumulated in a cavity in very insignificant degree worsens cardiac performance
Pleurisy at Dressler's syndrome is shown by pains in side departments of a thorax. Pains amplify at breath. Breath difficulty is characteristic. When listening the pleural rub is defined. Prostukivany a chest cavity points to accumulation of liquid in a pleural cavity in places of a dullness. Pleurisy can be unilateral and bilateral, dry (fibrinous) or exudative.
Fever at a syndrome Dresslera is optional. More often values of temperature rise not higher than 38 degrees, but can be also within norm.
Pneumonia is more rare symptom of a syndrome of Dressler. Patients can complain of cough with a mucous phlegm, sometimes – with blood impurity. When listening the big center of an inflammation rigid breath and wet rattles comes to light. On a x-ray film to come to light the small centers of consolidation of pulmonary fabric.
Joint disturbances usually affect the left shoulder joint. Inflammatory process leads to pains and restriction of mobility of a joint. Distribution of antibodies on an organism can lead to involvement in pathological process of other large joints of extremities.
At Dressler's syndrome heart failure, and also typical autoimmune manifestations – damages of kidneys (glomerulonephritis) and vessels can be observed (hemorrhagic vasculitis).
Reasons of the Syndrome of Dressler:
The main reasons leading to development of a syndrome of Dressler are the macrofocal and complicated myocardial infarctions, and also heart attacks complicated by bleedings in a pericardium cavity. Typical signs of a syndrome of Dressler can appear also after injuries of heart – cardiac interventions, wounds, contusions of heart, not getting blows in area of heart and some other reasons.
The autoimmune reaction arising in response to antigens of tissues of myocardium and a pericardium is considered the mechanism of development of a syndrome of Dressler. A part is played also by antigens of the blood getting through ruptures of a cardiac muscle into a pericardium cavity (an outside cover of heart). Antibodies to tissues of heart can be found also in patients without signs of a syndrome of Dressler, but at the diagnosed disease of an antibody are present at blood constantly and at a large number. At autoimmune reaction soluble cell-bound immune complexes which settle in various bodies are formed, leading to their damage.
At Dressler's syndrome in blood it is also observed a large number of cytotoxic lymphocytes (T-cells). Cytocidal cells are attacked and destroy the cells containing the corresponding specific antigens including own body tissues.
Treatment of the Syndrome of Dressler:
Non-steroidal anti-inflammatory drugs are considered as traditional remedy for autoimmune diseases. Sick appoint an ibuprofen or indometacin, is more rare – aspirin and its analogs. Other drugs of this group are not shown because of a possibility of negative influence on a zone around a heart attack.
In the absence of effect of anti-inflammatory drugs use corticosteroid hormones (Prednisolonum). Use of glucocorticosteroids should not be long as under their influence formation of aneurism and a rupture of a myocardium, and also braking of process of scarring of the struck fabrics and thinning of a hem is possible. Sometimes the good therapeutic effect is reached when using small doses of hormonal drugs in combination with anti-inflammatory drugs. In hard cases intravenous administration of glucocorticoids can be required.
Rare complication of a syndrome of Dressler is the cardiac tamponade. At a tamponade there is a heart prelum the liquid which accumulated in a pericardium cavity. In this case the pericardium cavity puncture (pericardiocentesis) for release it from liquid can be carried out.
