Echoes of the past: Dressler syndrome presenting with haemorrhagic cardiac tamponade

Background Dressler syndrome (DS) is a rare immune-mediated pericarditis occurring after myocardial infarction (MI). Although typically associated with a mild pericardial effusion (PE), progression to cardiac tamponade is seldom encountered. Case summary We report a male patient in his 60s who developed DS 10 days after an extensive anterior MI. While on dual antiplatelet therapy and anticoagulation, he developed progressive PE, which, despite anti-inflammatory treatment and discontinuation of anticoagulants, failed to resolve. He subsequently experienced haemodynamic compromise and multiorgan failure, with echocardiographic signs of cardiac tamponade requiring urgent pericardiocentesis and evacuation of 600 mL of haemorrhagic fluid. The patient recovered uneventfully. Follow-up cardiac magnetic resonance imaging revealed severe left ventricular systolic dysfunction, absence of viability in the infarct-related territory and no evidence of pericardial inflammation. Discussion This case highlights that DS, albeit rare in the reperfusion era, can still occur and may present with life-threatening haemorrhagic cardiac tamponade. In such cases, although still under debate, discontinuation of anticoagulation may be considered, underscoring the importance of vigilance and individualised management.