General responses to selected questions from Joel Braunstein, MD, of Johns Hopkins University and Joseph Toscano, MD.
Question:
My father developed Dressler's Syndrome after a massive MI. Ten days after discontinuing prednisone, his symptoms returned and he was again treated with prednisone. Do you have any information on how frequently it can return? Is there any basis for long-term low doses (5 mg) of prednisone?
Answer:
Dressler's Syndrome is also known as the post-heart attack syndrome, and usually occurs, if it occurs at all, one week to several months after a heart attack. In modern day acute management of heart attacks, this pericarditis-type syndrome has become quite uncommon, and occurs in less than a few percent of cases. The fact that your father developed this syndrome after a massive heart attack is consistent with the notion that one's risk for developing this syndrome increases with size of the heart attack. While the cause of Dressler's Syndrome is not entirely known, some believe there is an auto-immunological basis to its occurrence.
Typically, Dressler's Syndrome is treated with aspirin. As you pointed out, prednisone is occasionally used for treating severe, usually recurrent cases of Dressler's. While prednisone does inhibit immunological function (which is a rationale for using it to treat this disorder), its use is not recommended very early on after an acute heart attack because it may increase the risk of cardiac rupture. Unfortunately, because it is not uncommon for Dressler's Syndrome to become a long-term problem that is resistant to aspirin or non-steroidal anti-inflammatories (e.g. Naprosyn or Motrin), prednisone may seem like the only option for symptom control.
Many individuals may be refractory to prednisone, however. In these cases there may be some benefit to using colchicine, an anti-inflammatory used in the treatment of gouty arthritis. Another option is a pericardectomy, which is a surgical procedure to strip the surrounding pericardial sac that surrounds the heart and is the source of inflammation in Dressler's. Because of the potential complexity of this disorder, I would recommend your father see a cardiovascular specialist well-experienced in treating patients with chronic forms of pericarditis. Warmest regards to your father.
