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He had multiple cardiacarrests 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. CardiacUltrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism.
It was notable for a normal cardiacultrasound 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.
A bedside cardiacultrasound 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.
Myocardial rupture is usually preceded by postinfarction regional pericarditis (PIRP). Patients who present with chest pain or cardiacarrest 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.
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.
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