Abstract
IntroductionExercise testing is a safe diagnostic procedure which is widely used in the evaluation of patients suspected of having coronary heart disease or for the assessment of the prognosis in patients with established disease. Its complications are mainly cardiac disorders. Here, we report a rectus sheath haematoma as a complication of this procedure in a patient with acute coronary syndrome. To our knowledge, this is the first case report of rectus sheath haematoma in association with exercise testing.Case presentationA 72-year-old Caucasian woman was admitted for acute coronary syndrome. She received conservative treatment including low molecular weight heparin and anti-platelet agents. On the fifth day of her hospital stay, she underwent an exercise test, where no ischaemic response occurred. Several hours later, she experienced pain in the left side of her abdomen. Subsequent investigations revealed a rectus sheath haematoma. The patient underwent surgical haematoma evacuation. A few days later, re-operation was performed for recurrent bleeding in the abdominal wall. The patient had several characteristics known to increase the risk of bleeding during treatment for acute coronary syndrome.ConclusionAwareness of this possible consequence of exercise testing is important for preventing and treating it correctly. For prevention, an assessment of the bleeding risk of the individual patient is necessary before the test, and excessive anticoagulation must be avoided.
Highlights
Introduction: Exercise testing is a safe diagnostic procedure which is widely used in the evaluation of patients suspected of having coronary heart disease or for the assessment of the prognosis in patients with established disease
Exercise testing is a safe diagnostic procedure that is widely used in the evaluation of patients suspected of having coronary heart disease or for prognostic purposes in patients with established disease
We report a rectus sheath haematoma as a complication of exercise testing in a patient with acute coronary syndrome
Summary
Exercise testing is a safe diagnostic procedure that is widely used in the evaluation of patients suspected of having coronary heart disease or for prognostic purposes in patients with established disease. We report a rectus sheath haematoma as a complication of exercise testing in a patient with acute coronary syndrome. As continued haemorrhage was suspected, the patient underwent surgical exploration with haematoma evacuation, and received a blood transfusion She remained on a reduced dose of enoxaparin (1 × 60 mg). Since she was febrile and showed a decreasing haemoglobin level, on the 9th postoperative day a computed tomography (CT) scan was performed This showed a recurrence of the rectus sheath haematoma (Figure 1) and its extension in the abdominal wall.
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