Kardiogener Schock 4 Stunden nach akut-PTCA bei Hinterwandinfarkt

We report the case of a 67 year old male with acute inferior myocardial infarction and cardiogenic shock 4 h after successful PCI of the target vessel. Transthoracic echocardiography revealed pericardial tamponade due to guiding wire-induced coronary perforation. Echocardiographically guided pericardiocentesis was performed immediately and after evacuation of 80 ml of hemorrhagic pericardial fluid haemodynamics stabilized. We conclude that coronary perforation could become symptomatic even hours after PCI and therefore should be considered in all forms of post procedural cardiogenic shock. The use of echocontrast media facilitates emergency pericardiocentesis.