An Extraordinary Case of Silent Extensive Anterior Wall Myocardial Infarction Complicated with Giant Left Ventricular Aneurysm and Dressler Syndrome

Abstract

Early post-acute myocardial infarction (AMI) pericarditis, pericardial effusion with or without cardiac tamponade, and late post-MI pericarditis (Dressler syndrome), are the major pericardial complications after AMI. It is quite rare and estimated to be only about 0.1% in AMI patients according to a recent report, so it is easily neglected or misdiagnosed and may have tragic result to patient. Clinical features of this post-AMI complication include fever, chest pain, pericarditis and pleurisy occurring 2 to 3 weeks after AMI. Dressler syndrome is rarely associated with left ventricular aneurysm. Contrast enhanced magnetic resonance and echocardiography play important roles in diagnosis of left ventricle aneurysm. We report a 54-year-old male heavy labor worker who had asymptomatic, severe coronary artery disease, complicated with silent myocardial infarction, which resulted in large left ventricular aneurysm, and also systolic heart failure was noted. Patient was diagnosed to have Dressler syndrome after his second cardiology clinic follow-up. He received coronary angiography which revealed triple vessel disease with total occlusion of left anterior descending artery, and a giant left ventricular aneurysm was found. He received surgical intervention with Batista method and followed-up uneventfully at the cardiology clinic.

Dressler's pericarditis and an unusual vascular lesion of the myocardium

“…The co-existence of Dressler's pericarditis and LV aneurysmtwo distinct pathological sequelae of myocardial infarction, has been reported in the literature on several occasions although the incidence of both complications are decreasing in the reperfusion era [9,10]. Studies prior to the use of reperfusion therapy estimated the incidence of Dressler's pericarditis at around 3% post MI however in one cohort of 201 patients who underwent thrombolysis for acute MI, only one patient developed the syndrome [11].…”