Figure 2 - angiogram after PCI of RCA obstructive lesions (left anterior
oblique projection).
After the procedure, the patient remained asymptomatic and
hemodynamically stable. Echocardiography did not reveal pericardial
effusion either any other change in relation to the previous exam.
Patient was discharged next day with the following medication:
acetylsalicylic acid 100mg, Clopidogrel 75 mg, bisoprolol 2,5 mg,
atorvastatin 40 mg , ramipril 5 mg, metformin 1000mg and sitagliptin 5
mg. He maintained follow-up in cardiology consultation during 3 years
without any clinical intercurrence during this period.
Three years later the patient was admitted in the emergency department
after a syncopal episode preceded by chest discomfort and diaphoresis.
At admission patient presented with chest discomfort, diaphoresis and
widespread weakness and had signs of shock as hypotension, impaired
tissue peripheral perfusion (hiperlactacidemia 5,1 mmol/L), tachycardia
(120 bpm) and tachypnea (30 cpm) . EKG showed sinus rythm, 120 bpm, with
Q waves in DIII and aVF and 1 millimeter horizontal ST-segment
depression in V4, V5 and V6 derivations. Emergence echocardiography
showed a pericardial effusion with 25 mm in posteroinferior topography
and collapse of right cardiac cavities. It was performed an emergent
pericardiocentesis with immediate drainage of 1500mL of hematic-looking
liquid.
After clinical and hemodynamic stabilization of the patient, taking into
account his clinical background and the possible iatrogenic etiology of
hemopericardium, the cardiac surgery reference center was contacted and
the patient was transferred to that department to be submitted to an
emergent exploratory sternotomy.