Content area
Full Text
Background
Patients may present to emergency department (ED) with complaints both prior to and after endoscopy. The differential diagnoses for patients presenting with chest discomfort after upper endoscopy remain broad. In addition to infectious, traumatic and bleeding complications, intrinsic cardiac pathology needs to be considered by the treating provider. Though rare, pericarditis and pericardial tamponade are plausible entities that the clinician should entertain when evaluating any patient with non-ischaemic chest discomfort. 1 We report a case of acute pericarditis after upper endoscopy and outline the clinical features associated with this presentation.
Case presentation
A 74-year-old man presented to the ED with the chief complaint of substernal chest discomfort. The pain began acutely after awaking from endoscopy the day prior and had been constant since that time. The patient underwent upper and lower endoscopy the previous day for 4 weeks of chronic diarrhoea since returning from a trip to Thailand. This procedure was performed using fentanyl and midazolam for sedation without general anaesthesia or intubation. Random biopsies were obtained of the ileal and colonic mucosa during the endoscopies but no other interventions or therapies were performed. He had no chest pain or other thoracic complaints prior to the endoscopy. The patient reported associated shortness of breath and worsening chest discomfort with deep inspiration or lying flat. There was no fever, chills, cough, sore throat or vomiting. Medical history was significant for coronary artery disease and obstructive sleep apnoea. On evaluation by the ED physician, the patient was found to be in no significant distress, with a blood pressure of 168/55 mm Hg, heart rate of 81 beats/min, respiratory rate of 18 breaths/min and temperature of 36.3°C. Oxygen saturation was 96% on room air. Physical examination was unremarkable, with normal cardiac auscultation and normal lung sounds. Chest X-ray was obtained; radiology interpretation was small left pleural effusion and retrocardiac atelectasis ( figure 1A,B ). Additionally, ECG was performed, revealing a sinus rhythm with diffuse ST-segment elevation and PR depression ( figure 2 ). CT of the chest and echocardiography revealed a trace pericardial effusion, but no evidence of mediastinitis...