Patient handout

Cardiac tamponade — Dressler syndrome (post-cardiac-injury syndrome)

PRODUCTION

1. Your condition

This handout is for cardiac tamponade — dressler syndrome (post-cardiac-injury syndrome). Your care team identified this based on: low-grade fever + pleuritic chest pain (worse supine, better leaning forward) 2-12 weeks post-mi / post-cabg / post-pacemaker / post-ablation → dressler syndrome / pcis (esc 2015 §post-cardiac injury syndrome; imazio circs nejm 2015 pmid 26315582).

Other reasons your team may use this plan: recent (2-12 wk) cardiac injury (mi, cabg, valve surgery, lead implant, ablation, blunt trauma) with new friction rub + esr / crp elevation (imazio copps pmid 20447948); echo: new pericardial effusion 2-12 weeks post-cardiac-injury — variable size; tamponade physiology in ~10-20% of cases (esc 2015 class i; imazio jama 2014 pmid 25268438); recurrent pericarditis pattern (recurrent fever + pleuritic chest pain + friction rub + esr/crp recurrence) post initial pcis episode → multiple recurrences requiring colchicine + careful taper (imazio corp pmid 21788540).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	750-1000 mg PO TID × 1-2 wk then taper by 250-500 mg q1-2 wk per CRP normalization (total ~6-8 wk)	PO	TID with food + PPI prophylaxis	ESC 2015 §PCIS — preferred post-MI given continued antiplatelet benefit; high-dose anti-inflammatory effect; PPI prophylaxis essential for GI protection
ibuprofen	600 mg PO TID × 1-2 wk then taper to 400 mg TID × 1 wk then 400 mg BID × 1 wk	PO	TID with food + PPI prophylaxis	Imazio ICAP PMID 23992557 — alternative first-line if post-surgery or non-MI context; equivalent efficacy to ASA
indomethacin	25-50 mg PO TID × 1-2 wk then taper	PO	TID with food + PPI prophylaxis	Alternative NSAID — historically used in PCIS; AVOID in elderly + CHF + CKD due to CV / renal risks (ESC 2015)
colchicine	0.5 mg PO BID × 3 mo (0.5 mg daily if weight <70 kg or CrCl 30-60)	PO	BID × 3 mo	CORP-2 PMID 24239018 + ICAP PMID 23992557 + COPPS-2 PMID 25268438 — RR 0.56 reduction in recurrence; cornerstone of modern PCIS management; ALWAYS combined with first-line anti-inflammatory
prednisolone	0.2-0.5 mg/kg/d × 2-4 wk then SLOW taper over 6-8 wk (decrease by 5-10 mg/wk to 25 mg, then 2.5 mg/wk to 15 mg, then 1-2.5 mg q2wk to discontinuation)	PO	daily with slow taper	ESC 2015 — RESERVED for refractory cases or contraindications; LOW-DOSE preferred (0.2-0.5 mg/kg/d) — high-dose steroids INCREASE recurrence risk per CORP-2 + ICAP; very slow taper essential to prevent rebound
pantoprazole	40 mg PO daily	PO	daily	GI bleed prophylaxis essential during high-dose ASA / NSAID / steroid therapy; standard of care (ESC 2015)
acetaminophen	650-1000 mg PO q6h scheduled	PO	q6h scheduled	Analgesic adjunct + alternative if NSAID / ASA contraindicated; no anti-inflammatory effect
normal saline	500-1000 mL bolus	IV	rapid bolus then reassess	Bridge preload to drainage if tamponade physiology develops (ESC 2015)
norepinephrine	0.05-0.1 µg/kg/min titrate to MAP ≥65	IV	continuous	Bridge only if tamponade — does not address obstruction (Roy JAMA 2007)
azathioprine	1-1.5 mg/kg PO daily titrate to 2-3 mg/kg/d	PO	daily	ESC 2015 — third-line for refractory recurrent pericarditis; requires TPMT testing + LFT + CBC monitoring; consider rheumatology / cardiology multidisciplinary input
IL-1 receptor antagonist (anakinra)	100 mg SC daily	SC	daily × 6 mo then taper	AIRTRIP trial (Brucato JAMA 2016) — biologic for steroid-dependent refractory recurrent pericarditis; expensive but transformative for this subset; rheumatology / cardiology multidisciplinary input

Plan: Dressler / PCIS — high-dose ASA + colchicine first-line (preferred post-MI); NSAID + colchicine alternative (post-surgery); corticosteroids reserved for refractory (ESC 2015 §PCIS; Imazio CORP-2 Lancet 2014 PMID 24239018; Imazio ICAP NEJM 2013 PMID 23992557)

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent pericarditis (≥1 episode after symptom-free interval) → extend colchicine to 6 mo per CORP + restart anti-inflammatory
Multiple recurrences (≥2 episodes) → CORP-2 protocol + consider rheumatology consult
Refractory recurrent pericarditis with steroid dependence → azathioprine or anakinra per ESC 2015 + AIRTRIP
Constrictive pericarditis (rare in PCIS but possible) → CMR + RH cath + cardiothoracic for pericardiectomy
Tamponade recurrence → ED for echo + drainage

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Beck triad + echo evidence of tamponade physiology in PCIS patient — ~10-20% of PCIS cases develop tamponade requiring emergent pericardiocentesis (ESC 2015 Class I; Imazio JAMA 2014 PMID 25268438)(life-threatening)
Post-MI patient (2-12 wk post-event) presenting with chest pain — must differentiate Dressler vs re-infarction (ESC 2015; ACC/AHA STEMI 2025)
PCIS not responding to ASA / NSAID + colchicine after 1-2 weeks — escalation to corticosteroids required per ESC 2015 (LOW dose only)
Multiple recurrences (≥2 episodes after symptom-free intervals) with steroid dependence — escalation to biologic therapy (anakinra) per AIRTRIP trial (Brucato JAMA 2016)
PCIS patient on DAPT or anticoagulation with hemorrhagic effusion + tamponade — emergent reversal + drainage required (ESC 2015; Bhatt Circulation 2018)(life-threatening)

6. Sources

Guideline: 2015 ESC Guidelines for the diagnosis and management of pericardial diseases (Adler EHJ 2015 PMID 26320112) §Post-Cardiac Injury Syndrome — remains current as of 2026-05-15. Imazio CORP-2 (Lancet 2014 PMID 24239018) + ICAP (NEJM 2013 PMID 23992557) + COPPS-2 (JAMA 2014 PMID 25268438) + CIRCS (NEJM 2015 PMID 26315582) anchor colchicine 0.5 mg BID × 3 mo cornerstone with RR 0.56 reduction in recurrence; ASA preferred post-MI given antiplatelet benefit; corticosteroids RESERVED for refractory with LOW-dose only to minimize rebound risk. Brucato AIRTRIP (JAMA 2016) anchors anakinra biologic for steroid-dependent refractory recurrent pericarditis.