Post-cardiac injury syndrome after a simple coronary stenting
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CASE REPORT
Post-cardiac injury syndrome after a simple coronary stenting Yoshiaki Kawase • Hideaki Ota • Munenori Okubo Junko Honye • Hitoshi Matsuo
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Received: 10 June 2014 / Accepted: 23 July 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract An 80-year-old male patient underwent a coronary angioplasty without signs of complications. The day after the procedure, the patient complained of chest pain. The electrocardiogram showed a widespread ST segment elevation. A chest X-ray revealed pulmonary congestion with pleural effusion. There was no significant pericardial effusion detected with an echocardiogram. An administration of diuretics was initiated. After he showed an improvement of symptoms, the administration of diuretics was tapered. However, a deterioration of the oxygenation level was re-observed. The echocardiogram confirmed a cardiac tamponade at this time. The oxygenation level recovered after pericardiocentesis and pleurocentesis. Postcardiac injury syndrome was suspected to be the cause of this clinical course, and the patient was given an intravenous administration of hydrocortisone followed by an oral administration of prednisone. All clinical parameters started to improve drastically. Keywords Percutaneous coronary intervention Post cardiac injury syndrome Pleural effusion Pericardial effusion
Introduction Post-cardiac injury syndrome (PCIS) is a rare complication after cardiac surgery and a myocardial infarction. PCIS is
Y. Kawase (&) H. Ota M. Okubo J. Honye H. Matsuo Department of Cardiovascular Medicine, Gifu Heart Center, 4-14-4 Yabutaminami, Gifu City, Gifu 500-8384, Japan e-mail: [email protected]
defined as a late developing pleuropericarditis, low-grade fever, elevated inflammation markers and pericardial or pleural effusion [1]. Most cases that develop following a major cardiac operation are shown as postpericardiotomy syndrome; or following a myocardial infarction, shown as Dresslers’s syndrome. However, there have been several reports which have shown PCIS after prolonged or complicated percutaneous coronary intervention (PCI) [2–4]. In this report, we present a case of PCIS, which occurred after a simple PCI.
Case presentation An 80-year-old male patient was admitted to our hospital for a diagnostic catheter procedure. He had been suffering from coronary artery disease and was implanted with an Endeavor stent: 3.0 9 30 mm (Medtronic, Minneapolis, MN, USA) in the middle of the left anterior descending coronary artery (LAD) in February 2012. He experienced instent restenosis and a PCI for this lesion was performed in August 2012. He had been free from symptoms for 5 months after the second procedure. Beginning January 2013 however, he started to experience the recurrence of angina pectoris on effort. He was re-admitted for a diagnostic catheter procedure on January 28, 2013. A coronary angiogram revealed a 75 % stenosis inside of the previously implanted stent (Fig. 1). A subsequent PCI for this lesion was undertaken.
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