Cardiogenic Shock & Pericardial Effusion


(Partially a cautionary tale. I'm 43yo F in decent health.)

Anyone have the above? It's NOT common. Nor did they think it was necessarily caused by PM, although they said the leads could have caused some of the inflammation. I didn't have a heart attack; I was hypoxic & started going into sepsis! 

PM inserted 21mo ago, but I just faced death. Discharged from hospital after 3 days, says "Cardiogenic Shock; Cardiac Tamponade; Hemorrhagic pericardial effusion, hypotension." No idea what caused this. Heart sac inflamed, I'm now on colchicine for 3mo. This is the biggest thing I've dealt with in my life. This was INTENSE!!!

I had terrible pain breathing in, specifically on my right side, my right shoulder, down my right arm. Even hurt my teeth. It was a sharp nerve pain. Something told me I should call 911, but I didn't (thought it was reflux or pulled diaphragm muscle, or I was being hypochondriac.) I dealt with it for about 36 hours. It was positional & not getting better.

Tuesday morning, my heart rate spiked to the point I couldn't even measure it, profusely sweating, clammy, dizzy. Kept saying "I need help. This isn't normal." 
I had to call 911 on myself. Fortunately, I'm 10 blocks from great hospitals, but the paramedics had to get me down four flights of spiral steps & my blood pressure was 50/20. dry heaving, passing out. It was AWFUL. No visitors because of covid. (Tested negative, also negative antibodies.) I 100% understand & respect it, still, not having visitors because of Covid is a very painful thing.

Was in shock, echo showed fluid, had a drainage catheter put in heart sac, about 50 cc'd drained over 24hrs, they removed it & pulled another 100+cc's. Bloody. Started to go back into shock- the pain was intense. Wasn't aware until later that was a moment of "maybe not make it." At that moment, the pain shifted from my sternum to the muscles in the back of my neck. Now it is mostly under my clavicle area. I knew I had Pericardial Effusion, but I didn't know my proper diagnosis until the end, so I REALLY didn't know how bad it was! (when the paramedics first arrived, I said "I really hope I called you guys here for no reason! I really hope this is a panic attack!")

I'd probably be dead had I not called. They told me I almost didn't make it twice at the hospital.

I want to warn people… Most have heard to call 911 for chest pain, even if atypical. But we don't always. Please learn from my mistake even if it's something else! (& if anyone has experienced this, please PM me or comment! I searched in forum, but only saw two posts in the past 10 years.) Good rule of thumb – if you feel like you should ask anybody if you need to go to the hospital, GO!



Thanks for sharing

by crustyg - 2021-01-23 03:11:02

It does sound as though your RV lead managed to nearly perforate the heart muscle and triggered a pericardial effusion. Had the lead actually perforated, the bleed into the pericardium would probably have killed you in an hour or so.

Did they replace your RV lead?  What's the follow up: echo in a couple of weeks?

Reply to Crustyg

by MissAshleigh - 2021-01-23 09:11:59

Wow!!! I'm not sure I know all the ways I could have died!

They didn't replace anything. They discharged me knowing I have a follow up echo and see my regular Cardiologist in 5 days (Tues.) 

They did a CT scan upon arrival & after pulling the drainage catheter. I had been feeling better until they pulled it... whoa Nellie! I had "heart rub" from that- felt like my heart was beating through syrup, but in truth, there was just no fluid around my heart at that point. They were checking for perforation (in whispers!,) also checked the leads & saw continued inflammation then. That's when they started colchicine. I had an echo each day, incl before discharge.

My cardiologist will explain more to me Tuesday; I wasn't 'with it' enough to understand much explanation. I saw a LOT of doctors & nurses & techs- blurry. I had almost no affect- I didn't care about anything until 48hrs in. Got annoyed and that was a good sign. Wasn't until 60hrs in that I even thought about my hair (complete knots- a lot ripped out!) or how I smelled or brushing my teeth! 

The colchicine won't be much fun

by crustyg - 2021-01-23 14:17:37

Interesting choice of drug for an anti-flammatory effect, but most (all?) of the NSAIDs cause some salt and water retention - and this could be an important side effect that they really want to avoid.

For decades, colchicine was the standard treatment for gout (it's a very good suppressor of the inflammatory response) but the side effects always ended up limiting its usefulness.

So glad that you've made it through: as you say, this was a close-run thing.  Take notes next Tue!  There's a lot to cover.

Interesting too, your comment about 'no affect'.  In Douglas Bader's autobiography after his near fatal 'plane crash in the 1930s, he described how he heard a nurse outside his room telling someone to be quiet, 'Shush, there's a young man in there dying' - and it jerked him back to reality, angry at himself for just letting go.

Update after Cardio Visit

by MissAshleigh - 2021-01-27 01:26:34

Again, everyone, call 911 for ANY BAD "WEIRD" CHEST PAIN!!! 

Crustyg, I haven't had a poor reaction to colchicine yet, fingers crossed!!! (I'm either hyper-sensitive or not at all,) Maybe a Black Box med? Not 100% sure but is hard on body. They have me taking once a day instead of twice due to my kidneys (which I thought were fine, they said "ok.")

Saw MY Cardio today, first ECHO then follow-up- I'm in Baltimore, MD (Ince @ St Agnes, but was @ Medstar Union Mem for "episode.") Dr Ince was SHOCKED, concerned, "young lady, this isn't a drill! You're 43, there's no reason for this." Somehow my records never transferred, so it took a while. 

He said: "Look, this isn't just idiopathic. This doesn't really happen for no reason- we need to KNOW WHY so it never happens again & we can keep you alive- based on bloodwork, I think there's something autoimmune we don't know. I'd like you to go to Hopkins Rheumatology, Dr ___, they love a challenge, should find you fascinating!" (I'm the queen of idiopathic stuff SMH. In 20's, I was "too young." Early 30's, they thought I was "drug-seeking." (It's Bmore. Can get drugs on street. They were OFF!)  Last 5-8yrs, they finally started to LISTEN. Literally all my health challenges have been continuous (they know now in my 20's, I had neuromuscular joint issues beginning, not "hypochondria or hysteria.") 

All very interesting. Considering the ONLY reason they caught my heart skipping 9.6 seconds was frequent TBI's & Neuro frustratedly referring me to a Cardio because it "couldn't hurt," and that's who diagnosed Bradycardia/SSS 4/2019.

Once again, I found out how close I was to flatlining. Multiple times. I got an advanced directive today- can't hurt. My parents are scared, 74 & 75yo. Both are agents immediately if I'm unconscious. Chose all "no measures" but added to please keep mouth moist even if dying.

What happened to me is RARE but often fatal. Please allllll be careful folks- it's better to be over-the-top cautious than be dead. 

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