Postmyocardial infarction (Dressler's) syndrome: report of a case with immunological and viral studies

A case of postcardiac injury syndrome presenting as acute mediastinitis

A 41-year-old man sought evaluation at the emergency department for pain in the anterior chest that had been ongoing for approximately 35 hours. The electrocardiogram showed marked ST segment elevation in the precordial leads. Cardiac biomarker levels were elevated. He subsequently underwent coronary angioplasty and stenting of the left anterior descending artery using two sirolimus-eluting stents. The following day, the patient complained of severe pain in his chest and shoulders. Computed tomography (CT) of the chest showed small gas bubbles around the aortic wall and mild pericardial thickening with subtle air densities, suggesting acute mediastinitis. With an impression of postcardiac injury syndrome and acute mediastinitis, he was treated with intravenous antibiotics and oral ibuprofen. Two days later, the patient had subjective improvement and the friction rub was no longer heard.

Incidence and significance of heartmuscle antibodies in patients with acute myocardial infarction and unstable angina

The incidence of heartmuscle antibodies was studied prospectively in 136 patients consecutively admitted for acute myocardial infarction (AMI) and in 95 patients with unstable angina. Heartmuscle antibodies were determined with the indirect immunofluorescence technique on days 1, 10, 20 and 30 in patients with AMI and on days 1 and 10 in patients with unstable angina. Heartmuscle antibodies were found in 16/136 AMI patients (12%) and in 3/95 (3%) with unstable angina. None of the AMI patients developed post-myocardial-infarction syndrome in the 2--4 weeks after infarction or during the one-year follow-up. The AMI patients with and without heartmuscle antibodies were comparable with respect to age, sex, site and size of infarction, incidence of early pericarditis and previous infarction.

Takotsubo cardiomyopathy complicated by Dressler's syndrome

Takotsubo cardiomyopathy is an increasingly recognised syndrome characterised by transient apical left ventricular dysfunction in the absence of significant coronary artery disease. We describe a case of Takotsubo cardiomyopathy complicated by Dressler's syndrome. To our knowledge, these two conditions have not previously been reported in combination.

The postcardiac injury syndromes

Late pericarditis following myocardial infarction, cardiac surgery, or trauma is referred to as postmyocardial infarction syndrome (PMIS) or postcardiotomy syndrome (PCS), respectively. The term postcardiac injury syndrome (PCIS) is used to encompass both these entities. PCIS is characterized by fever, pleuropericardial pain, pericarditis, and pulmonary involvement. Abnormal laboratory findings include leukocytosis, high sedimentation rate, and chest x-ray abnormalities of pleural effusion with or without pulmonary infiltrates. Evidence supports an immunopathic etiology; viruses may play a contributing role. The course is benign but rare complications include tamponade, constriction, anemia, and coronary bypass graft occlusion. Anti-inflammatory agents are helpful; indo-methacin and steroids are preferably avoided. Rarely, PMIS-like syndrome may occur following pulmonary embolism. Anticoagulation and steroids have been used successfully in the latter situation.

Positive indium-111 leukocyte imaging in post myocardial infarction syndrome

The diagnosis of post myocardial infarction syndrome (PMIS) is sometimes difficult because of the absence of a specific test. We report a 68-year-old man with PMIS who had a persistent accumulation of indium-111 oxine labeled leukocytes in the infarcted myocardium for 1 month. The uptake of leukocytes preceded the appearance of the main symptoms and disappeared with the clinical improvement after the therapy with steroids. Leukocyte imaging has a potential as a useful tool for early diagnosis, evaluation of therapy and assessing the mechanism of PMIS.

Development of circulating antiheart antibodies as a result of coronary bypass surgery

Antiheart antibodies have been implicated as a marker of postcardiotomy syndrome in patients undergoing coronary artery bypass. To assess the frequency of and contributory factors in the development of antiheart antibodies after coronary bypass procedures, 33 patients were examined for evidence of antiheart antibodies before and for seven days after routine coronary artery bypass operations. Overall titers of antiheart antibodies rose in approximately 66% of the patients. However, this rise was not accompanied by any major clinical symptoms. History of previous myocardial infarction or myocardial injury did not correlate with a higher frequency of development of antibodies. Antiheart antibodies appear to be a common consequence of coronary artery bypass operations and are not routinely associated with the development of postcardiotomy syndrome.

Epitopes of streptococcal M proteins shared with cardiac myosin

We present evidence that M proteins from three different serotypes of group A streptococci share epitopes with cardiac myosin. Rabbit antisera evoked by a purified fragment of type 5 M protein crossreacted with myosin, but not alpha-tropomyosin, actin, or myosin light chains. In enzyme-linked immunosorbent assays, the myosin-crossreactive antibodies were totally inhibited by type 5 M protein and partially inhibited by types 6 and 19 M proteins. The affinity-purified myosin antibodies opsonized type 5 streptococci, indicating that they were directed against protective M protein epitopes on the surface of the organisms. Immunoblot analyses demonstrated the binding of the crossreactive antibodies to myosin heavy chains. Sera from patients with acute rheumatic fever showed significantly stronger reactions with myosin than did sera from their siblings, hospitalized controls, or patients with poststreptococcal glomerulonephritis.

Cardiac rupture in post-myocardial infarction syndrome

A fatal case of post-myocardial infarction syndrome (PMIS) followed by a rupture of an inferior left ventricular aneurysm is described. Attention is drawn to the growing number of reports of aneurysm in PMIS, and the clinico-pathological significance of this association is discussed.