Out of comfort 2

A 44 year old man presents with chest discomfort and dyspnea for 2 weeks; these symptoms have markedly worsened over the last 4 days.

He is otherwise asymptomatic, with no history of paroxysmal nocturnal dyspnea or orthopnea. His medical, surgical, and family histories are unremarkable.

He only drinks socially, and has never smoked before.

An urgent 12-lead ECG reveals a rate of 106 bpm, with a regular rhythm. All leads show low voltage QRS complexes with electrical alternans.

Select Relevant Investigations
Bedside Echocardiography

Performed

There is a pericardial effusion measuring ~22 mm. All cardiac chambers appear small. Collapse of the right atrium is noted in more than one-third of the cardiac cycle, while end-diastolic collapse of the right ventricle is also present. The vena cavae are plethoric and dilated.
D-Dimers

Performed

D-Dimers: negative
Contrast CT Thorax

Performed

You realize that CT imaging of the thorax is probably not appropriate right now!
Cardiac MRI

Performed

You realize that cardiovascular magnetic resonance imaging (MRI) is probably not a good idea right now!

Select Relevant Management
Pericardiocentesis Stat
IV Fluids Stat
Inotropes Stat
IV Antibiotics