A 65-year-old man with a 3-week-old anterior STEMI treated with thrombolysis presents with fever, chest pain worse on leaning forward, and a pericardial friction rub. This late post-MI complication is best explained by:

• A Dressler syndrome — autoimmune pericarditis from released cardiac antigens ✓
• B Fibrinous pericarditis from direct extension of transmural infarction (epistenocarditis)
• C Purulent pericarditis from bacterial seeding during thrombolysis
• D Haemopericardium from early free wall rupture

Explanation

Dressler syndrome (postmyocardial infarction syndrome) typically presents 2–10 weeks after MI with fever, pericarditis, and pleuritis, caused by an autoimmune response to myocardial antigens released into the circulation after infarction. The delayed onset (weeks) distinguishes it from early epistenocarditis (direct pericarditis from transmural MI occurring within days) and early free wall rupture (days 3–5). The friction rub and positional chest pain confirm pericarditis. Treatment includes NSAIDs and colchicine; steroids are reserved for refractory cases.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.