Cardiovasc Imaging Asia.  2025 Apr;9(2):15-18. 10.22468/cvia.2024.00136.

Post-Cardiac Injury Syndrome in End Stage Renal Disease Hemodialysis Patient After Percutaneous Coronary Intervention for Non-ST Elevated Myocardial Infarction

• Kim T
• Ko KY
• Hwang JW
• Cho SW
• Kim SE

• KMID: 2568012
• DOI: http://doi.org/10.22468/cvia.2024.00136

Abstract

Post-cardiac injury syndrome (PCIS) is an uncommon complication arising from pericardial and myocardial damage, encompassing post-cardiac surgery, percutaneous intervention (PCI) for acute coronary syndrome, cardiac device implantation, and radiofrequency ablation. The etiology of PCIS is not clearly defined, with approximately 50% of cases remaining idiopathic. Manifestations and symptoms of PCIS vary significantly among patients. Herein, we report a rare case of a 62-year-old male with PCIS that occurred after PCI for non-ST elevation myocardial infarction in an end-stage renal disease (ESRD) hemodialysis (HD) patient. He suddenly developed chest pain, fever, low blood pressure, cold sweating, tachycardia, desaturation and cardiac tamponade with cardiogenic shock after one week of PCI. After emergency pericardiocentesis, he was able to come out of cardiogenic shock. Ultimately, his clinical symptoms improved further with concurrent long-term medical treatment such as non-steroidal anti-inflammatory drugs and colchicine. This case illustrates a rare and unusual case of a relatively subacute onset PCIS in an ESRD patient on HD following emergency PCI. Although pericardial effusion is commonly detected in ESRD patients on HD, cardiologist should not overlook PCIS in dialysis patients, given the potential resemblance to uremic pericarditis or effusion. In addition, imaging modality such as transthoracic echocardiography has significantly important roles in case of urgent situation in order to make differential diagnosis as like this case.

Keyword

Post-cardiac injury syndrome; Percutaneous coronary intervention; Non-ST elevation myocardial infarction