The postmyocardial infarction syndrome. The nonspecificity of the pulmonary manifestations.

IN A PREVIOUS REPORT,' we reviewed Dressler's original papers concerning the postmyocardial infaretion syndrome and added four case reports of our own. The syndrome as described by Dressler developed as early as 10 days and as late as 2 years following myocardial infaretion and had a pronounced tendency to recur. It comprised fever, pericarditis or pleuritis with effusion that was frequently hemorrhagic, and pneumonia with grossly bloody expectoration. It was in general a benign and self-limited condition but occasionally required pericardiocentesis for tamponade. More severe episodes were managed by Dressler with steroids, with apparently good effect. Dressler postulated that an autoimmune mechanism might be responsible for these manifestations.2-5 Gery and others have demonstrated homoantibodies against components of heart muscle in patients who have suffered myocardial infarction; however, these antibodies have been demonstrated in patients who did not develop the postmyocardial infaretion syndrome as well as in those who did, and Gery points out that the antibodies may play no role in the development of the syndrome.6 7 In our review of the literature we were impressed with the fact that Dressler 's extensive clinical experience had been associated with low mortality and therefore meager pathologic material. Reference was made in his articles to a report by Geever and co-workers8 concerning atypical, histologically similar pulmonary inflammatory reactions in patients dying with heart disease of varying etiology. Most of Geever 's pa-