Tamponade in Dressler's syndrome with immunological studies.

A 67-year-old widow developed asthma in 1956 and had had eczema since her youth. Skin testing showed her to be sensitive to pollen; pets and many plants made her wheeze, and she was sensitive to penicillin. For the past five years she had experienced a tight substernal pain on exertion and had had one episode of paroxysmal atrial tachycardia but without evidence of a myocardial infarct. Two weeks before admission she had had severe chest pain of sudden onset, which recurred on the day before admission. On physical examination she was found to be short of breath at rest and coughed up frothy sputum but no gallop rhythm or basal crepitations were present. The thyroid was not palpable, temperature was 37-5'C, blood pressure was 120/80 mm Hg. LDH 40 mU/ml; SGOT 30 mU/ml; E.C.G. T-wave inversion in lead aVF. Five days after admission she complained of pain in the epigastrium. The SGOT (160 mU/ml) and LDH (245 mU/ml) became raised and Q Vaves and S-T elevation appeared in leads III and aVF consistent with myocardial infarction. The pain occurred intermittently although the SGOT fell to normal. Ten days later a pericardial friction rub was heard at the apex. The following day