A 78-year-old woman was referred to the hospital when a third-degree atrioventricular block was detected during a routine examination.
The patient was admitted to the hospital and a temporary 7F endovenous electrode implanted into the right ventricle via the right internal jugular vein.
It was necessary to replace it five times during the first 24 hours due to insufficient atrial sensation.
On the third day of admission, a permanent pacemaker was placed through the left subclavian vein without incidents.
The next day the patient had a low-grade fever and was treated with cloxacillin on an outpatient basis.
Blood cultures were negative.
Ten days later, the patient was admitted again due to intermittent fever, dyspnea, cough and pleuritic pain in the right hemithorax.
The surgical wound was clean and painless.
The chest X-ray revealed cardiomegaly and a right pleural effusion.
The ECG showed a third-degree atrioventricular block with leakage rhythm.
There was no P-wave sensation, so the sensitivity of the auricular electrode increased and the device functioned adequately.
The next day the patient had greater dyspnea, jugular engorgement and lower limb edema.
Precordial location was established for the first time a strong pericardial friction on the region.
The echocardiogram showed pericardial effusion of 5 mm without right ventricular collapse.
The electrode wire was inside the right ventricular outflow tract.
C-reactive protein was 153 mg/dl, fibrinogen was 659 mg/dl and ESR was 57 mm in the first hour.
Antinuclear antibodies, cardiac muscle antibodies, complement and rheumatoid factor were negative.
Antibodies against Coxsackie B1 to B6 and Echovirus were also negative.
The patient was treated with diuretics and prednisone (30 mg/day).
His condition improved rapidly.
Two weeks later, the pericardial friction and pleural effusion had normalized inflammatory markers.
The prednisone dose was gradually replaced two months later until it was stopped, with recurrence of symptoms (pleuritic chest pain and elevated inflammatory markers) two months later.
She was treated with a new course of prednisone with no further recurrences.
