Post-Cardiac Injury Syndrome following Percutaneous Coronary Intervention: A Rare Case Report

Background: Post-Cardiac Injury Syndrome (PCIS) is a rare inflammatory condition following cardiac interventions like PCI, characterized by pleuritic chest pain, fever, pericardial effusion, and ECG changes. Its pathophysiology involves autoimmune responses or micro-extravasation. Though rare (< 0.5% incidence post-PCI), early recognition and treatment are crucial to prevent complications. Case Presentation: A 69-year-old male with unstable angina underwent an unsuccessful PCI for mid-LAD CTO. Eight hours later, he developed pleuritic chest pain and low-grade fever. ECG showed widespread ST-elevations with PR-segment depression, and echocardiography revealed mild pericardial effusion. Inflammatory markers were elevated, but cardiac troponin I remained negative. Despite no visible extravasation on fluoroscopy, micro-extravasation was suspected. A diagnosis of iatrogenic PCIS was made, and he was treated with high-dose aspirin, leading to symptom resolution by day five. Conclusions: This case underscores the importance of recognizing PCIS post-PCI, even in the absence of visible extravasation. Early diagnosis through clinical signs, ECG, and inflammatory markers enables prompt treatment with NSAIDs, primarily aspirin. With appropriate management, outcomes are favorable, though monitoring for recurrence and long-term complications like constrictive pericarditis remains essential.