In a case with cardiac arrest due to ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) is necessary when return of spontaneous circulation (ROSC) is achieved. However, chest compressions may cause severe trauma and subsequently massive hemorrhage because loading of high-dose dual antiplatelet therapy (DAPT) is necessary in a case with STEMI [1]. To detect fatal hemorrhagic complications such as hemothorax, cardiac tamponade, and mediastinal hematoma, careful monitoring of hemodynamic parameters is necessary even after successful coronary revascularization. We report a case with obstructive shock caused by mediastinal hematoma after successful primary PCI, which was successfully surgically treated.
Case reportA 75-year-old man with a history of hypertension presented to a clinic in his neighborhood because of dizziness. Soon after arrival, he lost his consciousness due to pulseless ventricular tachycardia. Medical staff at the clinic immediately started cardiopulmonary resuscitation (CPR). After chest compressions and repeat electrical defibrillation for more than 10 min, ROSC was achieved. Then the patient was transferred to our hospital. When he arrived at our hospital, electrocardiogram showed ST elevation in V1-4 leads (Fig. 1), and a diagnosis of STEMI was made. A physical examination revealed the following findings: body temperature, 36.5 C; blood pressure, 77/47 mmHg; pulse rate, 89/min and regular; and oxygen saturation, 98% on 4 L oxgen. The findings of a laboratory analysis were as follows: white blood cell count, 9100/mL (with a normal