THE DEADLY PACE

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Myocardial perforation remains as a rare but important complication of pacemaker insertion. Perforation can occur acutely within 24 h after implantation, sub-acutely between to one month implantation and chronically occurring more than implantation. (Sidhu). Acute perforations are well described at medical literature, chronic much less common be difficult diagnose (Ahmed). This is the case atypical presentation right ventricular caused by RV ICD lead presenting with tamponade left sided compression atelectasis. CASE PRESENTATION: A 73-year-old Male PMHx A-Fib, CHF class II, A-HTN, NIDDM, RA, PUD, TAA, S/P placement 3 months before presentation, that comes ED pleuritic chest pain, dizziness, SOB fatigue evolution. Patient states symptoms slowly worsened over last days. At physical examination was found BP 90/40, HR 105 bpm, RR 21rpm Sat 95% in acute distress, using accessory muscles muffled heart sounds + JVD. COVID-19 Ag negative. EKG shows sinus tachycardia low voltage on precordial leads. bedside echocardiogram large pericardial effusion physiology, emergent pericardiocentesis performed. total 515 ml bloody fluid removed patient vital signs improves. Chest CT scan later confirmed presence accumulation The relocated septum avoid future. DISCUSSION: In circumstances when develops time, it may cause atelectasis surrounding bronchi lung (Amin). Compression better cases or subacute literature. most hypoxemia. placement, sudden onset cardiac no hypoxemia an perforation. rapid time pericardium, what causes this space stretches accommodate excess fluid, CONCLUSIONS: wasn't Is very not assume any sequelae recent intervention present like life-threatening clinical scenario. As clinicians we need keep mind causing atelectasis, without physiology. REFERENCE #1: Sidhu B, Rajani R, Rinaldi C. Chronic Ventricular perforation: Expect Unexpected. Clin Rep. 2019, 7: 455-468 #2: Ahmed A, Shokr M, Lieberman R. Subacute hemothorax epicardial hematoma. Cardiology. 2017: 1-5 #3: Amin H, Gyawali Chaudhuri D. culminating collapse. Cureus. 11: e5287 DISCLOSURES: No relevant relationships Jesse Aleman, source=Web Response Francisco Caraballo, Greisha Gonzalez Santiago,