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Systolic dysfunction after pericardiocentesis: A case report of Pericardial Decompression Syndrome

Rationale: Pericardial decompression syndrome is under appreciated but potentially fatal complication post pericardiocentesis. It should be part of differential diagnosis if patient presents with severe shortness of breath or hemodynamic compromise post-intervention. Prompt management is central to successful outcomes
Patient concerns: An interesting 69 year old gentleman who was initially treated for myelodysplastic syndrome and thereafter converted to acute myelogenous leukemia presented with neutropenic fever.
Diagnosis: On routine investigations it was identified that patient had large pericardial effusion. Soon after the identification of large pericardial effusion, patient’s condition deteriorated and had hemodynamic collapse.
Intervention: An emergent pericardiocentesis was performed successfully via sub-xiphoid approach
Outcome: Clinically the patient deteriorated the next day and we performed echocardiogram which showed a dramatic decrease in ejection fraction (from 60-65% to 35%). Over the course of next two days, the patient showed remarkable recovery with ejection fraction of 50% without any intervention
Lessons: Pericardial decompression syndrome is not a well-recognized fatal complication of pericardiocentesis. It should be part of differential diagnosis if patient develops hemodynamic compromise post procedure. Prompt management including supportive therapies, and/or administration of heart failure is crucial to the hemodynamic recovery. The major risk factor, based on a small case series, denotes surgical drainage as potential contributor. Large case control series needs to be pooled before bona fide risk factor can be ascertained.