VOTW: A Heart-y Effusion

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Case: A 62 yoF with a PMHx of CAD presented to the ED as a notification for shortness of breath. She began to worsen and was placed on BIPAP, pressors, and given IV fluids. Despite this, her BP dropped to 57/35 and her pulses became faint. Dr. Yu a bedside echo and saw a large pericardial effusion with tamponade (video 1). She then performed an emergent pericardiocentesis under US guidance and 75 ccs of bloody fluid was removed.

Video 1: subxiphoid view showing a large pericardial effusion with the heart swinging, right atrial, and right ventricular collapse.

Video 2/image 1: Needle tip at the top of the screen inside the pericardial effusion.

Case Conclusion: The patient’s BP immediately improved to 189/94 and she was weaned off of pressors before being admitted to MICU. Cardiothoracic surgery was consulted and the patient is scheduled for a pericardial window.

For more information on how to perform a pericardiocentesis in the subxiphoid approach: https://litfl.com/pericardiocentesis/

Happy scanning! 

Ariella Cohen 

 

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