A Middle-Aged Man with Chest pain, Hypotension and Tachycardia

In the evening, a middle-aged man complained of chest pain at the nursing home.  Nurses found him with a BP of 50/30 and heart rate of 130 and called EMS.He was awake, with a pulse of 130 and BP of 50/30.  Fluids were started. The patient arrived alert but cool and clammy.  His chest pain was vague.  He complained of chronic dyspnea.  He mentioned " cancer " and " chest " .Here was his prehospital ECG, which I viewed immediately while the resident performed cardiac ultrasound:What do you think?There is a narrow complex tachycardia at a rate of 130.  Is is sinus?  I could not see P-waves.  There is low voltage.The BP rose to 70/40 after some fluid was infused.Here is the cardiac ultrasound which the resident performed as I viewed the ECG:This shows a huge pericardial effusion.The IVC was very distended and there were no B lines.We could not get a very good view of the RV to assess for collapse.An ED ECG was recorded:What do you think?What do you want to do next?ECGs:there is a regular narrow complex tachycardia still at a rate of exactly 130, with no P-waves and also no change since the prehospital ECG.  Re-entrant tachycardias (atrial flutter, PSVT, AVRT, VT) have constant regular heart rates, whereas sinus tachycardia will usually gradually change rate with differing conditions (for instance, after infusion of fluid and BP increase, sinus tach rate might decrease from 130 to 125, for instance).  It is also possibly ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs