Dressler’s syndrome, a form of pericarditis

[Smudgebuttonjessie]

Has anyone on here experienced Dressler’s syndrome, this is a form of pericarditis which develops after heart surgery?

There is very little information about this condition as it is quite rare nowadays

[Kristin1812 Heart Star]

Do you have it? I was interested as I have had one, and only one, bout of pericarditis. But Dresslers syndrome does look quite rare now, as you say, and prevention and treatments sound to have had a good effect.

[Smudgebuttonjessie in reply to Kristin1812]

Hi, yes i currently have Dresslers which is not responding to treatment, i’m now on colchicine which is not working either, i had bypass surgery 8 weeks ago and developed Dresslers 6 weeks ago. I have never experienced pain like it, i have 6-8 attacks daily and each one feels like i’m having a heart attack with a pain score of 20 out of 10

[Kristin1812 Heart Star in reply to Smudgebuttonjessie]

Sounds really tough. I also remember the pain as worse than the HAs I had. The colchicine eventually worked......are they giving you pain relief? Oromorph worked for me.

[Smudgebuttonjessie in reply to Kristin1812]

I’m on Colchicine, Naproxen, Paracetamol, Codeine and Oramorph......the oramorph takes 2-3 mins to kick in but when your in absolute agony it feels like hours not minutes

[Kristin1812 Heart Star in reply to Smudgebuttonjessie]

I’m sorry you are having such a tough time. It seems to be a hard one to solve, though I would hope they can at least help you with the pain.

[Smudgebuttonjessie in reply to Kristin1812]

It’s that rare even the A&E consultants and GP’s have to look it up!!Can you remember how long yours lasted for?

[Kristin1812 Heart Star in reply to Smudgebuttonjessie]

Mine was just plain and simple pericarditis. It lasted just a few days, and then the pain faded over the following few. I was an inpatient, and they checked with echo’s. They were v keen to give me ibrupofen but my stomach can’t take them at all. I only had mild recurrences of pericarditis afterwards. Did they suggest Ibrupofen to you?

[Smudgebuttonjessie in reply to Kristin1812]

They put me on Naproxen at first, expecting it to work after a few days and be completely cured after 2 weeks, then they added Colchicine and was expecting the same outcome but 1 week in and i’m as worse as ever. I’m hoping i don’t end up back in surgery but if it gets rid of this then so be it

[Kristin1812 Heart Star in reply to Smudgebuttonjessie]

Fingers crossed. I hope it works well, and doesn’t take too long. If you can, try and keep calm....it can only help!

Let us know how you get on.

[Smudgebuttonjessie in reply to Kristin1812]

Thank you for your support, will keep you posted, stay safe x

[Sunnie2day]

I apologise in advance for a very long reply. Unfortunately I have extensive personal experience of Dressler's.

My Dressler's (caused not by surgery but by a bout of Dengue Fever contracted whilst living in Guatemala) became recurrent pericarditis. It's always been a very rare complication of surgical or viral infection and usually happens to people who have some other heart condition before the surgery or infection - in my case, Rheumatic Heart Syndrome caused by a childhood case of undiagnosed strep throat progressing to rheumatic fever. You're right - it is such a rare complication medics rarely think of it unless they spend hours trawling through books or online when they have a perplexing case of pericarditis.

Colchicine, if the patient tolerates it, is the go-to medication for any acute pericarditis but it doesn't always work even when the patient can tolerate it. I can't and they worked that one out during the time I had Dressler's. Only your medics can decide but if a patient either doesn't respond or shows side-effect symptoms after 2-3 weeks, they give up on Colchicine and go to either anti-inflammatories or nothing at all except pain relief.

The pain of such an acute case of pericarditis progressed to being diagnosed as Dressler's is frankly horrific. A low dose Oramorph can be given 'prophylactically' but they don't like to do that as it is so addictive - and they like you to be in hospital if they're giving it prophylactically. If you're home and they feel they can trust you, they can give you low-dose Oramorph tablets you take at spaced intervals during the day, pain or no pain. For those who can tolerate it and don't appear to be 'addictive personalities', using it prophylactically works. (I can't tolerate morphine in any form so when I'm in an acute flare, I take aspirin - I have what they call an exceptionally high tolerance for it).

Still, it is worth asking if they can prescribe or administer a low-dose prophylactic course, it can be worth the 'dopey' affect to have a small amount in your system to keep the pain down (don't take any life-changing decisions whilst on, understand you may find yourself constipated, feel some nausea, and you may be 'easily irritated' on it as well).

Sleeping with your upper body slightly elevated and if you are a side sleeper, avoiding sleeping on your left side (to keep body weight off your pericardium, sleeping on your right side eases the pressure) with your upper body elevated helps.

A hot water bottle against your left side also helps. But avoid hot steamy showers no matter how good the heat feels directed along the left side of your rib cage from breast to back - humidity is your enemy with an acute case of pericarditis especially when it's progressed to Dressler's.

Also it is VERY important to force yourself not to push yourself to regain fitness - it seems counter-intuitive but 'pushing' to regain fitness only causes relapse. For the foreseeable future you need to go low and slow - as long as you have any pain, you must not try to 'walk through it'. You may wake up one morning pain-free and feeling quite well, HUZZAH, you've recovered! Only once you try to actually do something more strenuous than walk from bed/sofa to bathroom and kitchen, you quickly realise, oh hey, not at all recovered! Pain hits like a HGV going 60mph and the next thing you know you're back in bed for three-five days. So, do not push!

Things to watch for: oedema, especially at ankles and digits. Very important to be alert to night coughing which indicates an alarming amount of fluid build up in the pericardial sac - ANY night coughing should be reported to the medics first thing the next morning even if relieved during the night by sitting up and leaning forward. Night coughing (when lying down even with upper body slightly elevated) means cardiac tamponade - the pericardial sac is becoming dangerously full of fluid or blood and is an emergency situation.

Cardiac tamponade is life-threatening without immediate treatment but if sitting up and leaning forward when the coughing wakes you at night works, you're safe to wait till morning to report it - otherwise, ring 999 for an ambulance and be sure to tell them you're in an acute flare of severe pericarditis with night coughing suddenly happening. That usually results in a very fast blue-light to A&E and a cardiologist or pericardial specialist (if you are lucky enough to live in a trust with one or more available) on stand-by to do a bedside echo and possible pericardiocentesis (also known as a pericardial window, don't worry too much, they do give you anaesthesia for it).

Owing to the pandemic you are likely not being chest-checked weekly at your surgery for pericardial friction rub - it's a unique sound heard through the stethoscope and it takes training to be able to distinguish it from other sounds. If you can get your consultant to agree, at least every few weeks it is very helpful to have that chest-check, your GP surgery nurse should be able to do it but he/she must be trained to hear the rub (or lack of it).

The presence of it indicates the case is still acute, the lack of it means you are finally in a recovery stage and can VERY CAREFULLY begin working towards regaining fitness - start with no more than five minutes round-trip walking, very slowly, 2.5 minutes up and 2.5 minutes to get back, and only with your medic's approval. You can increase incrementally per doctor's instruction/permission.

You've recently had bypass so you're also coping with recovery from that - getting through Dressler's is going to be slowed by that recovery process, so patience is your primary goal, I'm afraid.

It can take months out of your life to recover from Dressler's and you should be monitored for at least two years to be sure there is no residual pericardial effusion that can lead to being diagnosed with recurrent pericarditis. Monitoring is best done as twice yearly echocardiograms - the NHS doesn't always get that monitoring programme in place so if you can, consider going private for those regular scans.

Again I apologise for the extremely lengthy post. Feel free to copy and paste to a word doc for printing out and posting on the fridge.

[Smudgebuttonjessie in reply to Sunnie2day]

Thank you so much for your reply, i can relate to everything you say, the pain is horrific, the slightest thing triggers it off, i get them during the night and i haven’t moved, i sleep upright as you say, i kept going to A&E saying it can’t be just the Dresslers but they say it is, you are right, my cardiac rehab is a weekly telephone call, ive been driving myself mad as no one seems to understand what i’m saying, i am at home and have regular pain relief for the surgery and oramorph for the acute episodes, i can only tolerate a low dose of morphine as i am highly sensitive to it as we found out after my surgery, i was fit and well in no medication 6 weeks before the surgery, i was involved in a high speed vehicle accident, after 4 weeks the achey chest pain didn’t go away and i suddenly had an angina attack, after ecg, x-rays, angiograms, echo’s the found i had a rare non clinically presenting 99% blockage in my ostial main left stem which resulted in me requiring the urgent open heart surgery only to recovery to develop a rare complication of Dresslers,

[Sunnie2day in reply to Smudgebuttonjessie]

Unfortunately, the pain and other symptoms of Dressler's are indeed 'just the Dressler's' but as I wrote in my first reply to you, it's important to be alert to the signals it is progressing to an even worse stage (night/lying down coughing being the most important sign to watch for). And to make things even worse, there is only one surgical intervention - pericardiocentesis - and it's not a cure, is only done in an emergency (cardiac tamponade), and isn't fun to have although it does bring near-immediate relief from the cardiac tamponade pain.

But the pain can also be other things, so every time the pain drives you to A&E, they need to rule out those other things, just in case. If they do the investigations (chest x-ray, echo, bloods to check for troponin and other indicators of actual heart attack or acute infection) and tell you 'It's just the Dressler's', they're probably right - but they should always at least do bloods, just in case.

Keeping in mind I'm not medically trained, just a 'been there-done that-got several tee-shirts', lol, the car wreck both saved your life (led to the discovery of the blockages) and sadly predisposed you to Dressler's - any sort of impact like that incurred during a car wreck can do it. There are people who have had an impact-related event give them pericarditis even without any surgical intervention, btw. But whatever led to your blockage may be an undiagnosed life-long condition as well - really, that wreck, as unpleasant as it must have been, saved your life despite the horror of Dressler's (and Dressler's is horrific, made worse by the fact there is no surgical intervention that can cure it).

I sent you a message (at the top of the left side of the page you'll see a conversation bubble next to word Chat, click it to read the message) with links to the BHF pages on pericarditis and the Heart Helpline contact details. The cardiac nurses on the helpline are amazing. The pericarditis page is actually helpful although it doesn't mention Dressler's or recurrent pericarditis, I usually have a look at it two or three times a year if not more often.

Welcome to the forum, the club you never wanted to join. But you will find lots of support and not a few useful tips on coping with heart health issues here. We call ourselves Hearties and we're international, varied ages (I'm in my 60s but we have members here as young as late teens going up to the 80s) and genders - I'm a Lady Heartie, we also have lots of Gentlemen Hearties so we're a good mix, all of us with different conditions and happy to share if it means helping someone else get through the scariest time of their life.

[Smudgebuttonjessie in reply to Sunnie2day]

I thought i was a lonely heartie, i am a 50yr old lady, i can’t thank you enough for your response, you are the kind of person i was hoping to find on here when i wrote my post. I am medically trained as i am an emergency medical technician on the ambulances, although i know of pericarditis it’s just basic knowledge, nothing in depth. It was in the ambulance that i had the accident. I believe the accident saved my life, i was a ticking time bomb and they say it’s hereditary so my children are now aware of it and are speaking with their own GP’s who have agreed to monitor them. I’m not used to being the patient. I will say when i’ve been to A&E they have checked for everything, they do bloods, x-rays, echoes i had CT angiogram and everything came back as satisfactory or as expected which is good.

Once again i thank you for your support and information, you have. even my leading light in this x

[Sunnie2day in reply to Smudgebuttonjessie]

Is there an 'blushing' emoji? Thank-you - and I predict in three months time you too are going to have waaaaay more knowledge of pericarditis in all its unlovely forms than you ever wanted to have.

Oh wow, wrecking in an ambulance could not have been more unhappy - I'm assuming you were the EMT attending the patient so you may not have been strapped in when the wreck happened, you're VERY lucky (blessed) to have come through it!

[Smudgebuttonjessie in reply to Sunnie2day]

Yes i’m an EMT, I was the driver, i was driving a patient in to A&E, we were all ok in the accident, the ambulance was a right off and 3 of the deers sadly died instantly. Like i said it saved my life.

I’ve looked through all my medical books and there is a lot about pericarditis in general but not specifically Dresslers. I have access to medical journals and funnily enough the A&E consultant was looking at the same one as there isn’t many on there.

I just want to get better and get back to work asap but i guess this is going to be a long recovery.....at least i’ll be off for Christmas and New Year, i was originally on night shifts