Rapidly progressive dyspnea

Jihad A. Mustapha, MD, and D. Luke Glancy, MD

From the Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center and the Medical Center of Louisiana, New Orleans, Louisiana.

Corresponding author: D. Luke Glancy, MD, Section of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, Room 441, New Orleans, Louisiana 70112.

The electrocardiogram shown in Figure 1 is from a 56-year-old man who came to the emergency department because of the recent onset of progressively worsening dyspnea. The tracing shows sinus tachycardia and striking alternation of the QRS complexes in every lead except aVL. More subtle changes are slight ST-segment elevation confined to leads V₃–V₅; slight PR-segment depression in leads 1, 2, aVF, V₃–V₆; alternation of T waves in leads 1, V₄–V₆; and alternation of P waves in lead V₁. The electrocardiogram is virtually pathognomonic of pericarditis with a large pericardial effusion and tamponade (1, 2), a diagnosis confirmed by his symptoms, markedly elevated neck veins and striking pulsus paradoxus. After pericardiocentesis of 1100 mL of serosanguineous fluid, the electrocardiogram continues to show sinus tachycardia and subtle ST-segment elevation and PR-segment depression (Figure 2). (BUMC Proceedings 2002;15:95-96)