A 68-year-old man is 72 hours post-STEMI with persistent fever, pleuritic chest pain, and a new pericardial friction rub. ECG shows diffuse ST elevation without reciprocal changes. This presentation is MOST consistent with:
- A Early pericarditis (1st week post-MI)
- B Left ventricular free wall rupture
- C Dressler's syndrome (post-cardiac injury syndrome) ✓
- D Reinfarction at 72 hours
Correct answer: C. Dressler's syndrome (post-cardiac injury syndrome)
Explanation
Dressler's syndrome (post-cardiac injury syndrome) classically presents 2–12 weeks post-MI with fever, pleuritic chest pain, pericardial friction rub, and ECG showing diffuse ST elevation (pericarditis pattern, without reciprocal changes). It is an immune-mediated inflammatory response to necrotic myocardium antigens. Early pericarditis occurs in the first 1–3 days and is more localised. Free wall rupture presents with haemodynamic collapse, not a friction rub pattern.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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