Cardiac tamponade due to right coronary artery perforation following pacemaker implantation: a case report.

Background: Cardiac tamponade due to perforation of a cardiac chamber is a rare complication occurring in only 0.3% of patients undergoing permanent pacemaker (PM) implantation. Notably, perforation of the right coronary artery (RCA) following permanent PM implantation has only been reported twice in the literature. We report a rare case of RCA perforation leading to life-threatening cardiac tamponade with symptom onset 4 days after PM implantation. Case summary: A 75-year-old woman underwent permanent PM implantation without any difficulties in placing pacemaker leads and with good thresholds. Four days later, the patient was readmitted in a state of shock due to cardiac tamponade. A blood gas analysis on the bloody pericardial effusion raised suspicion of ongoing arterial bleeding. A CT scan ruled out aortic dissection; instead, the source of bleeding was identified as a perforation in the RCA, which was managed surgically. Discussion: This case highlights the necessity of coronary artery perforation being among the differential diagnoses of cardiac tamponade after PM implantation, and it stresses the usefulness of performing a blood gas analysis on the bloody pericardial effusion.

Lemierre syndrome.

Lemierre's syndrome is rare and characterized by an oropharyngeal infection with thrombophlebitis of the internal jugular vein (IJV). Septic microemboli can spread to the lungs or abdomen. This case describes a patient who presented with a sore throat, unilateral swelling on the neck and diffuse abdominal pain. Imaging showed a thrombus in the right IJV. The patient developed septic shock and was treated with antibiotics, anticoagulants, and intensive care support. The most common causative organism is Fusobacterium necrophorum. Early diagnosis and treatment are crucial for reducing mortality.

Post-injection delirium/sedation syndrome after treatment with olanzapine depot.

Treatment with olanzapine depot is associated with a rare but potentially adverse reaction, namely post-injection delirium/sedation syndrome (PDSS), characterized by delirium and/or sedation. This is a case report of a 38-year-old male patient who developed symptoms consistent with PDSS shortly after receiving intramuscular injection of olanzapine depot. Clinicians should be aware of PDSS and observe patients for three hours after receiving the injection, measuring vitals and referring to medical care if necessary.

Increased liver markers in rhabdomyolysis in a young recruit from the field trip.

We present a case report of rhabdomyolysis after intense physical activity. Tests showed increased creatine kinase compatible with rhabdomyolysis. Liver damage was suspected due to a significant elevation of aspartate transaminase (AST) and alanine transaminase (ALT). This case report discusses how an increase in AST and ALT reflects skeletal muscle damage in rhabdomyolysis instead of liver damage, especially when assessing more specific liver markers such as international normalised ratio and ϒ-glutamyl transferase, which both were within normal range in this case. This knowledge can prevent unnecessary test.