Remove Cardiac Arrest Remove Pericarditis Remove Ultrasound
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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

He had multiple cardiac arrests with ROSC regained each time. Dyspnea, Chest pain, Tachypneic, Ill appearing: Bedside Cardiac Echo gives the Diagnosis 31 Year Old Male with RUQ Pain and a History of Pericarditis. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism.

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A woman in her 70s with chest pain

Dr. Smith's ECG Blog

It was notable for a normal cardiac ultrasound with no pericardial fluid, normal LV and RV function (though the quality was not sufficient to evaluate for wall motion abnormalities) and normal IVC dynamics. Bedside ultrasound is another very important piece. Ultrasound can be very helpful to distinguish causes of hypotension.

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A woman in her 20s with syncope

Dr. Smith's ECG Blog

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. The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. This patient is only pseudo-stable.

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Cardiac Arrest, hypotension, tachycardia

Dr. Smith's ECG Blog

Myocardial rupture is usually preceded by postinfarction regional pericarditis (PIRP). Patients who present with chest pain or cardiac arrest and have an ECG diagnostic of STEMI could have myocardial rupture. In a report of 6 cases at our institution (Hennepin County Medical Center), 2 survived with cardiac surgery.

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Chest pain and hypotension in a patient who is 3 weeks post STEMI

Dr. Smith's ECG Blog

They also did an ED bedside ultrasound, shown here : This shows a large amount of pericardial fluid, with some echogenic structures that appear to be thrombi or fibrinous exudate. Differential of peri-infarct pericardial fluid The differential includes 1) pericarditis with effusion or 2) hemopericardium. These patients may survive.