Objective Delayed cardiac tamponade is an uncommon complication of percutaneous coronary intervention (PCI). Anterior spinal artery syndrome (ASAS) induced by cardiac arrest due to cardiac tamponade is rare. We report such a case and discussed the causes and prevention measures.
Case report This is a 78 year-old man admitted for exertion angina for 3 months. He had implanted with a VVI cardiac pacer 3 months ago for sick sinus syndrome in other hospital. On physical exam: His Blood pressure was 150/80 mm Hg and heart rate 55 bpm. His lungs were clear on auscultation. Neurological exam was normal. The coronary angiography showed 75% stenosis in mid segment of right coronary artery (RCA), 50% in mid segment of anterior descending artery, 60% from ostium to proximal segment and subtotal occlusion of distal part of circumflex artery. A 3.0*24 mm drug-eluting stent was implanted in RCA and a 2.5*29 mm in circumflex artery after pre-dilation. 6 h later the patient complained pain in xiphoid process, back and neck. The monitor displayed blood pressure 69/57 mm Hg and heart rate 54 bpm. Dopamine was administered with simultaneous transfusion of 250 ml saline and the blood pressure returned to and maintained at 100/60 mm Hg within 30 min. 4 h later, cardiac arrest occurred and the patient lost consciousness. Cardiopulmonary resuscitation was performed immediately and bedside echocardiography found cardiac tamponade. Pericardiaocentesis was performed and 200 ml bloody fluid was withdrawn. Heart beat recovered and blood pressure returned to normal level. 10 h later, the patient woke up and was talkative, but could not move legs. He also had bladder and rectal incontinence. Neurological evaluation was as follows: cranial nerves without changes, absence of pain from umbilicus down, preserved deep sensitivity, deep tendon reflexes abolished and muscle tone decreased in legs. Computer tomography showed lacunar infarction of brain and degeneration of thoracic spinal column 5–9. Cerebrospinal fluid was clear with total proteins 230.6 mg/dl, WBC 7.0*106/l and IgG 580.0 mg/l. Anterior spinal artery syndrome was diagnosed and steroid, anti-platelet and anti-coagulation agents, vitamin B and butylphthalide were used. Rehabilitation therapy was introduced one month later. 3 months later, he regained urinary and fecal continence and could stand with a walker. The patient discharged half year later.
Conclusion In older patients with diffuse arteriosclerosis, delayed cardiac tamponade may occur after PCI and induce persistent hypotension, even cardiac tamponade, and result in ASAS. Therefore, close observation and immediate management are very important.