P149 AN UNUSUAL CASE OF CARDIAC TAMPONADE AND ST–SEGMENT ELEVATION MYOCARDIAL INFARCTION

Abstract

Abstract The case of a 70–year–old woman, a heavy smoker with lung cancer diagnosed in November 2020, is described. The patient underwent 4 cycles of chemotherapy and subsequently a maintenance therapy with atezolizumab. In May 2021, a control CT scan was performed, where multiple cerebral and left adrenal metastases were found. In June 2021, she underwent a cycle of panencephalic radiotherapy. On September 9, 2021, she needed to be admitted to the oncology ward of reference for the appearance, for a few days, of dyspnea due to light exertion and asthenia. In the ward, she was dyspnoic at rest with arterial hypotension (BP 90/60 mmHg). The ECG showed sinus rhythm 110 bpm, anterior STEMI in evolution. The cardiologist performed a bedside echocardiogram which showed abundant pericardial effusion and signs of haemodynamic commitment; akinesia of the apex and middle septum of the left ventricle; LVEF 35%. He was conducted in the angiography room and subjected to pericardiocentesis, guided echo, via the subxiphoid route. 650 ml of blood fluid were removed; on echocardiographic control, a clear reduction of the pericardial effusion was noted. The BP after the procedure went back to 140/80 mmHg and the HR was 100 bpm. Coronary angiography was performed which demonstrated critical stenosis of the mid–segment LAD. After a collegial discussion between the cardiologist and the oncologist which took into account: the presence of haematic pericardial effusion, brain metastatic lesions, a life expectancy <6 months and uncertain date of the heart attack, it was decided not to treat the coronary lesion. A total body CT scan, performed on 13 September, demonstrated widespread and irregular pericardial thickening with nodulations and enhancement due to neoplastic infiltration and the appearance of new metastases in the liver and pancreas. On 14 September, the patient died of respiratory failure. In the literature, only 2 cases are reported with some analogy with the one described. Conclusion A rare case of association between haematic pericardial effusion, cardiac tamponade, and myocardial infarction is reported; the priority was to drain the pericardial effusion while the complexity of the case required a collegial assessment between oncologist and cardiologist which led to the decision of not to treat coronary artery lesion on LAD, due to the high risk of bleeding, the short life expectancy and the uncertain date of the heart attack.