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Dressler Syndrome — RACP Adult Medicine MCQ

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ModerateCardiologyDressler SyndromeRACP Adult Medicine

A 55-year-old man with an inferior STEMI treated with PCI 5 weeks ago develops fever, pleuritic chest pain, pericardial friction rub, and a new pleural effusion. CRP is 120 mg/L. ESR 85 mm/hr. Echo shows a moderate pericardial effusion. Anti-heart antibodies are positive. What is the most likely complication?

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Correct answer: C — Post-MI pericarditis (Dressler syndrome)

Fever, pleuritic chest pain, pericardial rub, pleural effusion, elevated inflammatory markers, and anti-heart antibodies 2-10 weeks after MI is Dressler syndrome (post-MI autoimmune pericarditis). It is an autoimmune reaction against exposed myocardial antigens. Treatment: aspirin (preferred) or colchicine + NSAIDs. Corticosteroids only for refractory cases (increase myocardial thinning risk). Anticoagulation should be used cautiously (risk of haemopericardium).

Reference: ESC – 2015 – Pericardial Disease; CSANZ 2025