Author: William Wilson, Gokul Sagar Bailur / Editor: Sarah Edwards / Codes: CC5, CP1, CP2, SLO1, SLO3, SLO6 / Published: 06/10/2025
A 54-year-old man presents to the emergency department (ED) with acute onset shortness of breath and chest discomfort that began suddenly while watching television.
He describes the pain as a dull pressure in the centre of his chest, worsening when lying flat and relieved by sitting forward. He reports feeling lightheaded and notes some swelling in his legs over the past week. His past medical history includes metastatic lung cancer, currently on chemotherapy.
On examination, His blood pressure is 92/60 mmHg, heart rate 118 bpm, respiratory rate 24/min, and oxygen saturation 86% on room air. Heart sounds are muffled. Peripheral pulses are weak and there is mild bilateral ankle oedema. Lungs are clear to auscultation.
On examination:
He appears anxious and diaphoretic.
Pulse 118, BP 88/50mmHg, RR 27/min and spO2 89 RA
CVS- S1 S2 heard. No murmurs.
RS- reduced air entry at the bases, otherwise normal
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Key Learning Points
- POCUS proves as a great tool for immediate bedside assessment of life-threatening conditions and should be used as an extension of examination.
- On ECHO- effusion+ RV/RA collapse + IVC plethora think Tamponade
References
- McCanny P, Colreavy F. Echocardiographic approach to cardiac tamponade in critically ill patients – PubMed Journal of Critical Care. 2017 Jun 1;39:271-7.
- Kovacevic M, Cooper JM, Krater R, Kovacevic M. Point-of-Care Ultrasound in Early Identification of Tamponade: A Case Series. Cureus. 2025 Feb 10;17(2).
- Imazio M, De Ferrari GM. Cardiac tamponade: an educational review. European heart journal. Acute cardiovascular care. 2021 Jan 1;10(1):102-9.
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Question 1 of 2
1. Question
An ECG is performed.
Image 1 [Courtesy of the authors]
Which of the following is the most probable ECG diagnosis?
CorrectIncorrect -
Question 2 of 2
2. Question
You perform a bedside and obtain the following images. {click the images}
Image 2 - Parasternal Long Axis view [Courtesy of the authors]
Image 3- Apical 4 chamber view [Courtesy of the authors]
The ECG and ECHO findings are consistent with?
CorrectIncorrect
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3 responses
I had a similar case of cardiac tamponade .
Bedside POCUS makes a huge difference
Clear illustration of US findings in pericardial effusion.
Great Revision