A woman in her 20s with syncope

Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and GrauerA woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope.Her initial vital signs revealed a temp of 97.7F, HR 125, RR 20, BP 115/90, and an oxygen saturation of 95% on room air. Upon arrival, she did not appear in acute distress. She was noted to be tachycardic and her heart sounds were distant on physical exam. She had a normal respiratory effort, and her lungs were clear to auscultation bilaterally.Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained:What do you think?The ECG shows sinus tachycardia, a narrow, low voltage QRS with alternating amplitudes, no peaked T waves, no QT prolongation, and some minimal ST elevation in II, III, and aVF (without significant reciprocal STD or T wave inversion in aVL). The beat-to-beat variation in QRS amplitude and morphology is electrical alternans.A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below:There is a large pericardial effusion with collapse of the right ventricle during systole. It is difficult to tell if there is collapse during diastole due to the patient ’s tachycardia. However, if you freeze the ultrasound clip and scroll forwards and backwards to find a time during the clip where the patie...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs