Tamponade

A 46 year old male diagnosed with Kahler's disease, complains of fast progressive dyspnea. Physical examination reveals tachcardia (140 beats per minute). Upon measuring hois blood pressure the nurse notices a pulsus paradoxus of 30 mm Mercury. Further examination shows decreased lung sounds on the right and dampened percussion on his back on both sides.

You see the ECG which shows a tachcardia and a pulsus alternans, typical for pericarditis

ECG of a patient with pericarditis carcinomatosa and tamponade

The apical 4 chamber echocardiogram shows severe pericardial effusion and a swinging heart.

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An apical 4 chamber view of a swinging heart

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