Huge cardiac origin #Pericardial-effusion. Relieved with #Pe | Figure 1

surgmed

Huge cardiac origin #Pericardial-effusion

Relieved with #Pericardiotomy "window" and drain. 600 cc fluid removed in OR

Images

Trending cases

70yo F pericardial effusion 1st picture #Tamponade #Echocardiography 2nd picture successful #pericardiocentesis

SYNCOPE AT THE PHARMACY!!! 60+ y/o male with PMH of HTN/HLD/DM/Hypothyroid present to ER post syncopal episode. Patient fell during episode. Xray showed right humorous fx. Head CT/Ultrasound carotid/ultrasound bilat LE neg for anything acute, EKG as shown, cbc/cmp/mg/TSH normal other than elevated WBC at 12 and hg of 10, procalcitonin 1.25, resp pcr neg.

Vitals- bp 88/70, Sp02 92% on 6L, resp 25/min, pain 10/10 right shoulder, temp 99.5. Meds- In ER NS 250 ml given, morphine 2mg, Zofran 4 mg. ICU- Upon arrival to ICU vitals remained the same, pt c/o worsening SOB, lungs clear, patient became apprehensive, an TTE was done and showed...

  1. What did TTE show?
  2. Are there any clues in the ECG as to what’s going on with the patient?
  3. What do ECG show?
  4. What interventions do you anticipate in this patient?
  5. What is the best way to support this patient’s blood pressure? Fluids? Vasopressors or inotropes?
  6. What is your ddx for syncope?

Image 1 shows a normal Parasternal long axis image. Image 2 shows fluid in the pericardial space (pericardial effusion). PE was measured at 28 mm. Image 4 shows a circumferential fluid around the heart in the subcostal view.

Continued from previous case: ECHO images.

Additional Cases

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history.