Postcardiac injury syndrome complicated by pleural and pericardial effusion following transvenous pacemaker insertion

Abstract

Post-cardiac injury syndrome is an immune-mediated inflammatory process involving the pericardium and, to a lesser extent, the pleura, epicardium, and myocardium. It usually happens following cardiac surgery, myocardial infarction, or cardiac trauma, but can also develop after interventional procedures like transvenous pacemaker implantation. We present the case of an 83-year-old patient who underwent pacemaker upgradation(from VDD to DDR) with fixation of a new atrial screwing lead following the end of the life of the pulse generator. He presented to the emergency department within one week of the procedure with fever, chest pain, worsening respiratory difficulty, new onset pericardial and bilateral pleural effusion, and raised blood inflammatory markers. The patient responded well to anti-inflammatory medication and therapeutic pleural tapping and was subsequently discharged.