The Postmyocardial Infarction Syndrome

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Abstract
Following Dressler''s reports of a "postmyocardial infarction syndrome" in approximately 3% of patients hospitalized under his observation with myocardial infarction, an approximately equal incidence of the same clinical manifestations was noted at the reporting institution. The authors were impressed, however, with certain differences between the pleuropericardial manifestations, on the one hand, and the pulmonary manifestations, on the other. In general, the pleuropericardial manifestations tended to occur as a relatively benign process with low mortality and with little relation to very recent infarction of the myocardium or to manifestations of cardiac failure. The pulmonary changes, on the other hand, very frequently were associated with gallop rhythm, right-sided decompensation, very recent infarction of the myocardium, and far-advanced heart disease with associated reasons for left-sided decompensation (such as disease of the aortic valve). The prognosis in these patients was in general extremely unfavorable, and when they did recover they did so under the influence of measures directed at congestive heart failure. Use of steroids in this condition, as recommended by Dressier, was limited in the authors[image] experience; however, they were used in adequate dosage in one patient with the pulmonary manifestations without altering the histologic picture at postmortem examination 5 days later and without any apparent effect on the clinical course. These considerations, as well as a clinicopathologic study of the syndrome, led to the conclusion that the pulmonary manifestations may be an unusual form of left ventricular failure and etiologically distinct from the pleuropericardial manifestations. Five case reports are submitted in support of these conclusions.