Infero–lateral Stemi Complicated by Dressler’ssyndrome With Massive Pericardialeffusion: Integrated Management and Ventricular Recovery

Background Dressler’ssyndrome, a rare post–infarctioninflammatorycomplication in the era of earlymechanicalreperfusion, mayoccurseveral days after the acute ischemic event. We report a case of infero–lateral STEMI complicated by no–reflow and subsequentpleuro–pericardialeffusion, successfullymanagedthrough a multidisciplinaryapproach. Case Presentation A 66–year–old obese, hypertensive man in good therapeutic control presented with chestpainduringexertion. ECG showed an evolved infero–lateral STEMI. Echocardiographyrevealed an ejectionfraction (EF) of 30% with infero–posterolateralakinesia. Urgentcoronaryangiographydemonstrateddiffuselyatheromatous vessels and a rightcoronaryartery (RCA) with muralaneurysms and TIMI 1–2 flow. PCI with drug–elutingstentimplantation on the distal RCA wasperformed. No–reflowoccurred and wastreated with intracoronary adenosine and tirofibaninfusion (Figure 1). The coursewascomplicated by intermittent second–degree AV block (2:1) (Figure 2) and a circumferentialpericardialeffusion (28 mm) with earlyright–sidedcompression, treated with colchicine, NSAIDs, and pericardiocentesis (900 mL of citro–hematicexudate). Bilateralpleuraleffusion (55 mm on the left one) wasdrained (2 L of citrine fluid) (Figure 3). Discussion This case underscores the complexity of post–STEMI evolutioneven in the reperfusion era. The coexistence of no–reflow, conductiondisturbances, and Dressler’ssyndromerequiresvigilant monitoring and prompt, coordinated management of inflammatory and mechanicalcomplications. Early use of colchicine, NSAIDs, and drainage led to resolution of effusions and hemodynamicstabilization. Conclusions Although rare, Dressler’ssyndromeremains a possible late inflammatoryevolution after STEMI. Earlyrecognition and integrated treatment allowed clinical improvement and partial recovery of leftventricularfunction (EF 37% atdischarge).