Six weeks after a large anterior myocardial infarction, a 60-year-old man presents with fever, pleuritic chest pain, and pericardial friction rub. ESR is elevated and echocardiography shows a small pericardial effusion. The underlying mechanism is:

• A Recurrent thrombotic occlusion of the infarct-related artery
• B Direct bacterial extension from a contiguous pneumonia
• C Immune-mediated reaction against altered cardiac antigens ✓
• D Uremic toxin deposition on the pericardium

Explanation

Dressler syndrome appears one to eight weeks after infarction and is caused by an autoimmune response against myocyte antigens exposed by necrosis, generating antimyocardial antibodies that inflame the pericardium and pleura. Recurrent infarction would show fresh troponin rise and ECG re-elevation, not a delayed friction rub alone. Uremic pericarditis occurs in renal failure, not six weeks after MI, eliminating D.

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

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Written and medically reviewed by the StethoPrep medical team.