Image IQ: Shortness of breath and hypotension

July 2, 2019

A 68-year-old man was rushed to the ED with shortness of breath and hypotension after passing out at home. EMTs reported tachycardia and decreased heart sounds, and noted the patient’s neck vein was distended. What's your diagnosis?

A 68-year-old man was rushed to the ED with shortness of breath and hypotension after passing out at home. EMTs reported tachycardia and decreased heart sounds, and noted the patient’s neck vein was distended. The patient’s wife noted that he had been complaining of unusual fatigue the past few days. An ECG showed low QRS voltage.

This patient is showing symptoms of:

A. Cardiac tamponade
B. Tension pneumothorax
C. Congestive heart failure
D. Pulmonary embolism

See the next page for the answer.

ANSWER:  A) Cardiac tamponade

Compression exerted on the heart by the accumulation of blood or fluid in the pericardium, compromising cardiac output. Primary symptoms are shortness of breath accompanied by hypotension and tachycardia. Other findings include cyanosis, peripheral leg edema, chest pain, decreased heart sounds, fatigue, tachypnea, syncope, anuria, oliguria, pericardial friction rub, and pulsus paradoxus. Similar etiology as pericardial effusion or hemorrhage, including a wide variety of infections, autoimmune diseases, autoinflammatory disorders, tumor growth, trauma, radiation, iatrogenic causes, and cardiac or metabolic abnormalities. Rarely drug induced.

Quick identification and treatment by drainage of the fluid is essential.

For more information about this diagnosis, including ICD 10 codes, visit VisualDx.

Click here for differential diagnoses.

REFERENCE:

This quiz was provided courtesy of VisualDx.