永久ペースメーカー挿入後の心臓損傷症候群と脳卒中

Postcardiac injury syndrome and stroke following permanent pacemaker insertion.

• Caitlin Bialy
• Edmund Wee
• Nizam Uddin

抄録

80歳の女性が、デュアルチャンバー永久ペースメーカーを植え込んだ10日後に胸膜性胸痛を訴えた。嘔吐と発熱を訴えて1日後に再来院した。右側脱力と構音障害に加えて新たに心房細動が認められた。後にCTで左前下小脳動脈領域の梗塞が確認された．その後も嘔吐と呼吸困難を伴う発熱を繰り返していた．感染症の精密検査は陰性であったため，当初は誤嚥性肺炎が原因と考えられていたが，抗生物質の投与により徐々に悪化していった．抗生物質の投与にもかかわらず、患者は徐々に悪化し、大きな胸水と心嚢液を伴った息切れが進行した。他の鑑別を除外した後、心不全後症候群の診断が下された。患者は胸膜穿刺、心膜穿刺、心膜窓を行った後に順調に回復し、さらなる薬物療法を行わなくても症状は消失した。

An 80-year-old woman initially presented with an episode of pleuritic chest pain 10 days after implantation of a dual chamber permanent pacemaker. She returned to hospital a day later with vomiting and fever. She was found to have new atrial fibrillation in addition to right-sided weakness and dysarthria. An infarct in the left anterior inferior cerebellar artery territory was later confirmed on CT. She continued to have recurrent febrile episodes associated with vomiting and dyspnoea. Extensive investigations for infection were negative, and her symptoms were initially attributed to aspiration pneumonia. The patient gradually deteriorated despite antibiotics and became progressively short of breath, with development of large pleural and pericardial effusions. A diagnosis of postcardiac injury syndrome was made after exclusion of other differentials. The patient recovered well after pleurocentesis, pericardiocentesis and a pericardial window, with resolution of symptoms without further medical therapy.

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