Dressler's Syndrome: The Heart Attack After A Heart Attack

Robert (his real name) thought he had been extremely lucky to survive a "widowmaker" heart attack. Even though the descending artery on the left front side of his heart was almost completely blocked by a blood clot and hardened, calcified cholesterol-laden debris, he was still able to sit up, take himself to the bathroom, eat, and shower. It was a lot better than the usual alternative, which involved burial.

But about a week after his heart attack, Robert felt a great deal worse. While his original heart attack had caused almost no pain, he felt awful from head to toe. His extremities turned blue. He could not catch his breath. He could not sit up and he couldn't reach the phone to call 911. 

Several hours after the onset of symptoms, Robert's landlord came banging on the door, found him unresponsive, and called for paramedics. Robert's EKG was so irregular it could not be interpreted. He seemed near death.

In the emergency room, however, the doctors found no evidence of a second heart attack. Instead, they concluded that Robert was undergoing a commonly experienced but seldom reported complication of heart attack recovery known as Dressler's Syndrome.

What Is Dressler's Syndrome?

Of the 12 million people worldwide who suffer heart attacks, about 1 million of the survivors will develop Dressler's Syndrome. There are about 150,000 cases per year in the United States and about 200,000 cases per year in Europe.

When a heart attack occurs, if the damage is not overwhelming, its injured tissues adjust to reduced oxygen levels and go into a kind of hibernation. As circulation is restored, however, some of these tissues cannot readjust to normal activity and they die. They have to be "cleared out" of the heart by the immune system by antibodies that attack heart tissue the same other antibodies attack bacteria, viruses, and other germs.

What Are the Symptoms of Dressler's Syndrome?

Dressler's syndrome is to the heart a lot like influenza is to the lungs. Dressler's syndrome causes massive inflammation. The 30% of men and 40% of women who suffer little or no chest pain at all during a heart attack may have intense chest pain with Dressler's syndrome.

The character of the pain caused by Dressler's syndrome, usually is not the same kind of pain that is caused by a heart attack or angina. An acute heart attack or angina typically causes dull, crushing pain that persists for minutes or hours. Dressler's syndrome causes twisting, burning, irritant pain that may come and go.

Dressler's syndrome can also cause fever, pain that gets worse with heavy breathing, and a "squeaky heart" due to a pericardial friction rub. The rubbing sound is due to friction of the heart beating against an inflamed pericardial sac surrounding it. The squeaky or rubbing sound can interfere with sleep, especially when the person who has the syndrome lies on the left side.

What You Can Do If You Are Diagnosed With Dressler's Syndrome

Dressler's syndrome often goes away after 3 weeks to 3 months, but there are a number of things individuals can do to accelerate their recovery. Here are five of the most important.

1. Don't take Indomethacin, the pain reliever marketed as Indocin, Indochron, Indocide, and Indomet.

Dressler's Syndrome causes inflammation and Indomethacin relieves it, but it also causes the breakdown of connective tissue in the heart that can trigger an even worse autoimmune reaction.

2. Ask your doctor about alternatives if you are offered corticosteroids for pain relief.

Corticosteroid drugs, such as Hydrocortisone, Prednisone, and prednisolone, definitely relieve the symptoms of Dressler's Syndrome. However, they can also raise blood pressure, cause fluid retention, and trigger rebound reactions when they are discontinued. Stopping steroids abruptly can leave you with worse symptoms than with which you began.

3. Ask your doctor questions if you are scheduled for injections of a blood thinner called Lovenox.

Lovenox, or low molecular weight heparin, is standard treatment for almost anyone in the hospital after a heart attack. However, if you have Dressler's syndrome, this blood thinner can cause bleeding into the pericardial sac that surrounds your heart, aggravating symptoms. It is even possible for Lovenox to cause a further complication of Dressler's syndrome known as cardiac tamponade, in which the heart cannot beat due to pressure within the pericardial sac.

The generic name name of Lovenox is enoxaparin sodium. It is also marketed under the trade names Clexane and Xaparin.

4. Be ready for a series of tests to determine whether you have blood clots in the lungs.

Doctors have a blood test that tells them when blood clots are not present in the lungs, the d-dimer test. Unfortunately, if you have Dressler's syndrome, the d-dimer test is likely to be ambiguous. In most hospitals, this means you will be subjected to a CAT scan to look for blood clots that may not be there. However, pulmonary embolism is a potentially deadly condition and it simply has to be ruled out--even if the test adds $5,000 to $10,000 to your bill.

5. Put off shots for flu and pneumonia.

Especially in the fall and winter, every heart attack patient is going to be offered immunizations for influenza and pneumonia. (The pneumonia shot is taken only once every five years.) If you have Dressler's syndrome, ask your doctor if you can wait. Immunizations are immune stimulants, and immune stimulation is the cause of symptoms in this syndrome.

Some people find Dressler's syndrome more debilitating and far more painful than the heart attack itself. The good news about Dressler's syndrome, however, is that it seldom results in fatality and almost always goes away, faster if it is treated properly.