APCU25CR4 Case report: acute pancreatitis: a rare post pci complication

Introduction Post-procedural complications following percutaneous coronary intervention (PCI) can be a significant source of morbidity. While hypotension is a common sign, it can stem from various causes. This case outlines a rare instance of acute pancreatitis presenting as post-PCI hypotension.Case Presentation A 61-year-old man with a history of hypertension and type 2 diabetes presented with a non-ST-elevation myocardial infarction (NSTEMI). He was subsequently diagnosed with sick sinus syndrome and two-vessel coronary artery disease. After receiving a pacemaker implantation, he was scheduled for a staged percutaneous coronary intervention (PCI). The patient remained stable until the PCI, which involved the placement of two drug-eluting stents in the left anterior descending artery. The technically difficult 120-minute procedure was uneventful, utilizing 120mL of Omnipaque 350 contrast without sedation. Approximately eight hours post-procedure, he developed severe abdominal pain, nausea, vomiting, and hypotension, requiring a single inotropic agent after a fluid bolus. His ECG showed a paced rhythm with intermittent premature ventricular contractions, while cardiac enzymes remained within the normal range. His serum amylase was significantly elevated at 1283 U/L. He was treated for acute severe pancreatitis (Ranson score: 3) with supportive therapy. His condition gradually improved, confirmed by a decline in serum amylase and his 48-hour Ranson score. An abdominal ultrasound revealed findings consistent with pancreatitis and gallbladder sludge. He was discharged home after five days.Discussion Post-coronary angioplasty hypotension is a concerning sign, with common causes including vasovagal attacks, bleeding complications, pericardial tamponade, myocardial infarction, and stent thrombosis. Acute pancreatitis is a rare but potentially life-threatening complication. Only a limited number of cases have been reported, with proposed mechanisms of injury including contrast agent toxicity and cholesterol emboli. The mainstay of treatment for pancreatitis is supportive care.Conclusion A careful and thorough assessment is critical when evaluating post-coronary angioplasty hypotension. Timely diagnosis and management are essential for treating acute pancreatitis.