Skip to main content

Health condition

Dressler's syndrome, pericarditis after a cardiac injury - and how to settle it.

A late immune reaction to a heart attack, cardiac surgery or trauma. Modern UK practice pairs NSAIDs or aspirin with colchicine, keeps steroids in reserve, and watches carefully for tamponade.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against ESC, ACC/AHA and peer-reviewed cardiology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK cardiology practice including colchicine as a first-line partner and steroid-sparing strategies.

Key facts

Dressler's syndrome at a glance.

The essentials, in plain English - what causes it, when it appears, and how it is treated in the UK today.

  • What it is

    An immune-mediated inflammatory syndrome affecting the pericardium and sometimes the pleura or lung after cardiac injury.

  • When it appears

    Typically 2 to 6 weeks after a heart attack, cardiac surgery, ablation, trauma or occasionally after PCI.

  • How common

    About 1 per cent after modern reperfused STEMI, but 10 to 20 per cent after cardiac surgery (post-pericardiotomy).

  • Cardinal features

    Fever, pleuritic chest pain worse lying flat, pericardial rub, and often a pleural effusion or pericardial effusion.

  • Foundation therapy

    High-dose NSAIDs (or aspirin post-MI) plus colchicine for 3 to 6 months, with PPI cover.

  • When to escalate

    Tamponade, large effusion, haemodynamic instability or recurrence needs urgent cardiology and possible pericardiocentesis.

Why this guide matters

A treatable syndrome, if it is spotted.

Recurrent chest pain after a heart attack or heart surgery is often assumed to be ischaemia. The three points below shape how modern UK cardiology approaches it.

  • Timing is the biggest clue

    Symptoms 2 to 6 weeks after a cardiac injury, with fever and pleuritic pain, point away from re-infarction and towards Dressler.

  • NSAIDs and colchicine together

    Colchicine added to first-line NSAIDs or aspirin halves recurrence and shortens the illness, based on the CORP and COPPS trials.

  • Steroids are a fallback, not a default

    Corticosteroids are effective but drive recurrence. UK practice keeps them low-dose and reserved for NSAID or colchicine failure.

How the diagnosis is made

From late chest pain to a settled plan.

The steps a UK cardiologist or acute medical team will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Recent cardiac event history

    A recent MI, cardiac surgery, ablation, PCI or chest trauma in the last 2 to 6 weeks is the crucial clue.

  2. 02

    Assessing

    Focused examination

    Listening for a pericardial rub, assessing JVP, looking for pulsus paradoxus and signs of tamponade or effusion.

  3. 03

    Assessing

    Inflammatory bloods

    FBC (leucocytosis), CRP and ESR are usually raised. Troponin is typically normal or only mildly elevated.

  4. 04

    Confirming

    ECG

    Diffuse concave ST elevation with PR depression is the classic pericarditis pattern and helps distinguish from re-infarction.

  5. 05

    Confirming

    Echocardiogram

    Confirms a pericardial effusion, assesses ventricular function and rules out recurrent ischaemic injury or tamponade.

  6. 06

    Confirming

    Chest X-ray

    Looks for a pleural effusion (often left-sided), pulmonary infiltrates and enlarged cardiac silhouette from a large effusion.

  7. 07

    Refining

    Cardiac MRI and specialist review

    Reserved for complex, recurrent or constrictive cases to characterise pericardial inflammation and thickening.

Typical timeline: first review to a working diagnosis within a day or two.

Symptoms

What Dressler's syndrome actually feels like.

The classic combination of pleuritic chest pain, fever and a pericardial rub - and the features that mean it is time to escalate.

  • Pleuritic chest pain

    Sharp central chest pain, worse lying flat and on deep breathing, relieved by sitting up and leaning forward.

  • Low-grade fever

    Persistent low-grade pyrexia is common and helps flag an inflammatory rather than ischaemic cause.

  • Pericardial rub

    A scratchy triphasic rub heard best at the left sternal border with the patient leaning forward.

  • Pericardial effusion

    Fluid around the heart, visible on echo. Large or rapidly accumulating effusions can cause tamponade.

  • Pleuritis and pleural effusion

    Pleuritic pain and a pleural effusion (often left-sided) are common features of the syndrome.

  • Malaise and fatigue

    A general unwell feeling with tiredness, poor appetite and reduced exercise tolerance.

  • Pulmonary infiltrates

    Patchy pneumonitis on chest X-ray reflects the immune-mediated lung involvement seen in some patients.

  • Red flag - tamponade

    Hypotension, raised JVP, muffled heart sounds and pulsus paradoxus - a cardiology emergency needing pericardiocentesis.

Treatment

How Dressler's syndrome is treated in the UK.

NSAIDs or aspirin plus colchicine as first line, corticosteroids in reserve, and cardiology-led drainage or surgery for the small number who need it.

  • Ibuprofen

    A first-line NSAID at 600 to 800 mg three times daily until symptoms and CRP settle, with a PPI for gastric protection.

  • Aspirin (post-MI)

    Preferred over other NSAIDs after a recent MI at 750 to 1000 mg three times daily, so dual antiplatelet therapy is not interrupted.

  • Colchicine

    0.5 mg twice daily for 3 to 6 months. Halves recurrence and shortens attacks. Supported by the CORP and COPPS trials.

  • Corticosteroids

    Low-dose prednisolone (0.2 to 0.5 mg/kg) with slow taper, reserved for NSAID or colchicine failure. Carries a higher recurrence risk.

  • Proton pump inhibitor

    Gastric protection alongside high-dose NSAIDs or aspirin, particularly in older or antiplatelet-treated patients.

  • Pericardiocentesis

    Drainage of a large or haemodynamically significant effusion, done in a specialist cardiology setting.

  • Pericardiectomy

    Surgical removal of the pericardium for recurrent or constrictive disease not controlled by medical therapy.

  • Anakinra or rilonacept

    IL-1 blockers for colchicine-resistant or steroid-dependent recurrent pericarditis, under specialist commissioning.

What this guide is based on

The sources behind every claim on this page.

UK and European cardiology society standards, plus the landmark colchicine trials, current at the time of last review.

Key references

Guidelines and trials we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your cardiologist or GP knows your history and can tell you which parts apply to you. If in doubt after a recent cardiac event, get seen.

  • European Society of Cardiology (ESC). Guidelines for the diagnosis and management of pericardial diseases.

  • ACC/AHA. Scientific statements on post-cardiac injury syndromes and pericarditis.

  • CORP and CORP-2 trials. Colchicine for recurrent pericarditis.

  • COPPS and COPPS-2 trials. Colchicine for the prevention of the post-pericardiotomy syndrome.

  • NICE Clinical Knowledge Summaries. Pericarditis and post-cardiac injury syndromes.

Red flags

When Dressler's needs urgent attention.

Most cases settle with NSAIDs and colchicine. These are the situations that need same-day cardiology input.

  • Cardiac tamponade

    Hypotension, raised JVP, muffled heart sounds and pulsus paradoxus. An emergency needing urgent echo and pericardiocentesis.

  • Large pericardial effusion

    A rapidly enlarging or circumferential effusion greater than 20 mm on echo needs urgent cardiology review even without frank tamponade.

  • Suspected re-infarction

    Rising troponin, dynamic ischaemic ECG changes or crescendo pain need re-evaluation for recurrent MI, not just pericarditis.

  • Constrictive pericarditis

    Progressive breathlessness, oedema and raised JVP months after the initial event suggests constriction and needs specialist imaging.

  • Steroid-dependent recurrence

    Frequent flares whenever prednisolone is tapered signal a need for IL-1 blockade under a specialist pericarditis service.

  • Haemodynamic instability

    Low blood pressure, tachycardia or reduced consciousness needs urgent admission for monitoring and drainage.

  • Fever above 38 degrees with rigors

    Raises the possibility of purulent pericarditis or bacterial superinfection and warrants urgent bloods, cultures and imaging.

  • Contraindication to NSAIDs

    Renal impairment, heart failure or bleeding risk means colchicine plus low-dose steroid may be needed instead - specialist input helps.

  • Pregnancy

    NSAIDs and colchicine have restrictions in pregnancy. Management should be coordinated with cardiology and obstetrics.

Living with it

A treatable illness, with a clear plan.

Four things that make the biggest difference: finish the course, pace your recovery, keep an eye on the numbers and know when to come back.

A quiet reminder

Steady recovery beats an early return.

Rushing back to activity or stopping colchicine too soon is one of the commonest reasons the pain returns.

  1. 01 Recovery

    Expect a full course

    Most people settle within weeks on NSAIDs and colchicine, but colchicine is continued for 3 to 6 months to prevent recurrence.

  2. 02 Activity

    Rest, then rehabilitation

    Avoid strenuous activity while symptomatic. Return to cardiac rehabilitation is guided by your cardiologist as inflammation settles.

  3. 03 Monitoring

    Track how you feel and the numbers

    Symptom diaries, repeat CRP and an interval echo help confirm resolution and pick up early recurrence.

  4. 04 Escalate

    Know when to come back

    Breathlessness, worsening chest pain, dizziness or leg swelling deserve prompt reassessment - do not wait for the next planned appointment.

Frequently asked

Everything we get asked about Dressler's syndrome.

Quick answers on timing, treatment, steroids and recurrence.

  • What is Dressler's syndrome?

    Dressler's syndrome is an immune-mediated inflammatory syndrome that develops 2 to 6 weeks after a cardiac injury such as a heart attack, cardiac surgery, ablation or chest trauma. It causes pericarditis, sometimes with pleuritis, pleural effusion and pulmonary infiltrates, and is thought to be driven by antimyocardial antibodies produced in response to the initial injury.

  • How common is it after a heart attack today?

    Much less common than it used to be. Historically 5 to 7 per cent of patients developed the syndrome after an MI, but with modern reperfusion therapy (primary PCI and thrombolysis) the incidence has fallen to around 1 per cent after STEMI. It remains more frequent after cardiac surgery, where 10 to 20 per cent of patients develop post-pericardiotomy syndrome.

  • How is it different from a second heart attack?

    The pain is pleuritic (worse on deep breathing and lying flat), a pericardial rub may be audible, the ECG shows diffuse concave ST elevation with PR depression rather than a regional infarct pattern, and troponin is usually normal. Echocardiography helps by showing a pericardial effusion and stable wall motion rather than new ischaemic changes.

  • What is the first-line treatment?

    High-dose NSAIDs (typically ibuprofen 600 to 800 mg three times daily) or aspirin after a recent MI, combined with colchicine 0.5 mg twice daily for 3 to 6 months. Colchicine both shortens the attack and halves the risk of recurrence, and is supported by the CORP and COPPS trials.

  • When are steroids used?

    Corticosteroids are reserved for people who cannot tolerate NSAIDs or colchicine, or whose symptoms fail to settle. Low-dose prednisolone (0.2 to 0.5 mg/kg) with a slow taper is preferred because higher doses are linked to more recurrences. Steroid-dependent disease may need IL-1 blockade with anakinra or rilonacept in a specialist centre.

  • Can it come back?

    Yes. Around a fifth of patients experience a recurrence, which is why colchicine is continued for several months and NSAIDs are tapered slowly. Recurrent or constrictive disease needs specialist cardiology input, and in a small number of cases pericardiectomy or long-term IL-1 blockade is required.

Related content

Keep reading.