What is the cause of hypotension? A rare complication of percutaneous coronary intervention of a chronic total occlusion: a case report.

Vetrugno, Vincenzo, Sharma, Harish, Townend, Jonathan N and Khan, Sohail Q (2019) What is the cause of hypotension? A rare complication of percutaneous coronary intervention of a chronic total occlusion: a case report. European heart journal. Case reports, 3 (4). pp. 1-5. ISSN 2514-2119. OPEN ACCESS Freely available. (Please note, publishers alter access arrangements regularly. We cannot guarantee that the access shown here will be available).

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Official URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC70421...

Abstract

Background

In the last few years, complex techniques and advanced equipment became available to treat chronically occluded coronary arteries. Such procedures portend a series of possible complications that operators should be ready to quickly recognize and deal with.

Case summary

A 75-year-old lady with uncontrolled stable angina underwent percutaneous treatment of a chronically occluded right coronary artery. After balloon angioplasty and stenting, she developed a severe hypotension, refractory to fluid resuscitation and vasopressors. Computerized tomography scan demonstrated an intramural haematoma (IMH) of the right atrioventricular groove resulting in life-threatening pseudotamponade (or dry tamponade), as further confirmed by cardiac magnetic resonance imaging (MRI). The decision was for conservative management and haemodynamic support by intra-aortic balloon pump. Clinically, the patient improved and was discharged a few days later. Follow-up MRI confirmed resolution of the IMH.

Discussion

Severe hypotension during percutaneous treatment of chronically occluded coronary arteries may be related to various causes. Differential diagnosis is thus important in this setting and should include IMH, a rare but potentially fatal complication as it may cause compression of cardiac chambers and lead to pseudotamponade. A high index of suspicion is required to diagnose IMH but there are no clear guidelines for management of such cases.

Item Type: Article
Additional Information: OPEN ACCESS Freely available. (Please note, publishers alter access arrangements regularly. We cannot guarantee that the access shown here will be available).
Subjects: WG Cardiovascular system. Cardiology
Divisions: Emergency Services > Cardiology
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Depositing User: Mr Philip O'Reilly
Date Deposited: 06 Mar 2020 14:56
Last Modified: 06 Mar 2020 14:56
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2913

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