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Patient
83-year-old man with an anterior infarction 10 years earlier, hospitalized 48 hours after the onset of typical chest pain; troponin peak on hospital arrival is high, the following electrocardiogram is recorded;
Trace
Sinus rhythm with a normal PR interval; there is poor R wave progression in the precordium compatible with the history of a previous anterior infarction; there is also a Q-wave in the inferior territory with persistence of a slight elevation with negative T-wave pointing to a recent lower infarction;
The coronary angiography confirmed the presence of a recent inferior infarction; no action of revascularization could be achieved. After a pain-free interval of 6 weeks, the patient is again hospitalized in the setting of prolonged chest pain with fever and cough;
Trace
The tracing reveals sequela of inferior and anterior necrosis; there is a significant modification of repolarization with presence of negative symmetrical T-waves in inferior leads and from V3 to V6; this tracing is consistent with a Dressler’s syndrome occurring as a result of non-reperfused inferior necrosis;
Exergue
Dressler’s syndrome corresponds to a pericarditis occurring a few weeks after an extensive infarction. Its incidence has considerably decreased since the development of reperfusion techniques. It should nevertheless be evoked in a non-reperfused or late-reperfused patient with typical symptomatology.
This patient presented an inferior infarction examined belatedly and without possible reperfusion followed by a Dressler’s syndrome a few weeks after the patient's discharge with the presence of moderate left pleural effusion, pericardial effusion and hyperleukocytosis.