Cardiac tamponade on 7th day after PCI – distant complication revealed by pharmacotheraphy
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Abstract
A 61-year-old man with a history of percutaneous coronary intervention (PCI) was admitted due to typical stenocardial symptoms of unstable angina pectoris. The first coronary angiography showed a 99% stenosis in the diagonal artery (DgII) and marginal restenosis in the right coronary artery (RCA). A PCI of Dg1 was performed. A few hours later, a chest pain accompanied with an increase in myocardial damage markers and ECG features of an inferior wall ST-elevation myocardial infarction (STEMI) were reported. The second coronary angiography showed a significant (70%) restenosis in the RCA - balloon angioplasty was performed without complications. The next day, the patient had an episode of atrial fibrillation. Direct oral anticoagulant inhibitor was added to the current dual antiplatelet therapy. Spontaneous conversion to sinus rhythm was observed within approximately 48 hours. On the 7th day, TTE revealed a large amount of fluid (25 millimeters near the apex) and signs of tamponade of the pericardial sac. In the third coronary angiography, a perforation in the distal segment of the DgII was observed and sealed using the snipped distal end of the balloon. On the 8th day of hospitalization, despite intensive treatment, the patient died. Our case demonstrates that cardiac tamponade can occur exceptionally late, 7 days after the PCI procedure and such a late presentation may lead to a fatal consequences.
Keywords: Cardiac tamponadeCoronary artery perforationCoronarography
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