Delayed cardiac tamponade after pacemaker insertion

Cardiogenic shock is one of the most dramatic presentations in Emergency Me dicine and requires rapid and accurate assessment, evaluation, and treatmen t. The cardiovascular disasters that present with shock include acute myoca rdial infarction with pump failure, aortic dissection, massive pulmonary em boli, and cardiac tamponade. We report a patient who presented to our Emerg ency Department (ED) in cardiogenic shock 10 days after insertion of a perm anent cardiac pacemaker. The patient had developed pericardial tamponade se condary to the insertion. In reviewing the literature, we found many report s relating to complications of pacemakers and even more information regardi ng the various etiologies of cardiac tamponade, but cardiac tamponade as a consequence of pacemaker insertion rarely has been reported. Cardiac tampon ade can occur secondary to perforation of the right ventricle during pacema ker electrode insertion and manipulation. Perforation is generally believed to be benign and self-limiting and only rarely causes tamponade and hemody namic compromise; however, that was not the case for our patient. (C) 2000 Elsevier Science Inc.