A patient develops chest pain and a pericardial friction rub 2-12 weeks after a myocardial infarction, with persistent fever. This is most consistent with which condition?

A patient develops chest pain and a pericardial friction rub 2-12 weeks after a myocardial infarction, with persistent fever. This is most consistent with which condition?

• A. Dressler syndrome
• B. Pleuritis
• C. Pericarditis due to viral infection
• D. Rheumatic fever

Answer: (A)

Dressler syndrome represents post-infarction pericarditis caused by an autoimmune reaction to myocardial antigens released during the infarct. It typically appears weeks after a heart attack—often around 2 to 12 weeks—and features chest pain with a pericardial friction rub plus persistent fever. This timing after MI with pericardial signs is the hallmark, setting it apart from other causes of chest pain or pericarditis. Pleuritis would mainly involve the pleura and not be tied to a recent MI with a pericardial rub. Pericarditis from a viral infection lacks the post-MI temporal link, and rheumatic fever follows a streptococcal infection with different clinical features such as migratory arthritis and carditis not specifically related to a prior MI. Therefore, the presentation fits Dressler syndrome best.

Dressler syndrome represents post-infarction pericarditis caused by an autoimmune reaction to myocardial antigens released during the infarct. It typically appears weeks after a heart attack—often around 2 to 12 weeks—and features chest pain with a pericardial friction rub plus persistent fever. This timing after MI with pericardial signs is the hallmark, setting it apart from other causes of chest pain or pericarditis. Pleuritis would mainly involve the pleura and not be tied to a recent MI with a pericardial rub. Pericarditis from a viral infection lacks the post-MI temporal link, and rheumatic fever follows a streptococcal infection with different clinical features such as migratory arthritis and carditis not specifically related to a prior MI. Therefore, the presentation fits Dressler syndrome best.