(253) Unexpected Turn: Abdominal Cramping to Cardiac Tamponade Post-Cardiac Catheterization

Introduction: Late onset cardiac tamponade is a rare but life threatening complication of Percutaneous Coronary Intervention.

Description: We present a case of a 66-year-old male with a history of hypertension, hyperlipidemia, coronary artery disease, who presented with an NSTEMI. He underwent left heart catheterization (LHC)and stent placement for a 90% distal RCA stenosis. Approximately 10 hours, post procedure patient complained of new onset cramping abdominal pain in right lower abdomen and strong urge to have a bowel movements.He appeared pale, extremely diaphoretic, was hypotensive to 80s/60s, tachycardic to 130s, and saturating at 100%. He felt like he was having extremely watery bowel movement although none were visualised. He denied any chest pain. Initially suspected GI bleed due to new onset abdominal pain for which he was given 1L fluid bolus, IV PPI and and emergent unmatched blood transfusion were ordered. He did not repsond to fluids and was started on norepinephrine and ICU team consulted. The vasopressors initiation did not make any improvement in his BP. Urgent point of care ultrasound performed which demonstrated large pericardial effusion with tamponade physiology and thus cath lab was activated. Patient was deemed too unstable for transfer to lab and an emergent bedside pericardiocentesis was performed. While undergergoing pericardiocentesic, patient's vitals started improving and post pericardiocentesis BP was 150s/80s, HR was 70. A total of 525 cc of frank blood was removed and a pericardial drain was placed. Patient was admitted to cardiac ICU and over the next few days he remained stable , drain output decreased and it was removed and serial echocardiograms did not demonstrate any residual effusion. Patient most likely had acute decompensation secondary to wire microperforation from his LHC. Patient was started on colchicine and remained stable. He was discharged to his home with close followup with cardiology.

Discussion: This case emphasises the importance of prompt recognition and intervention in cardiac tamponade post cardiac catheterization, and how abdominal symptoms can initially mask an underlying sinister cardiac process. The critical role of bedside POCUS in expediting diagnosis and guiding emergent management remains pivotal.