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William R. Jacobs, MD; James V. Talano, MD

Arch Intern Med. 1978;138(7):1125-1126.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

A middle-aged man with a history of surgery for bronchogenic carcinoma was initially seen at the emergency room with weakness. Physical examination disclosed a paradoxical pulse of 15 mm Hg and on a chest roentgenogram, the cardiac silhouette was greatly enlarged. The ECG was abnormal; the echocardiogram is shown (Fig 1). What is your diagnosis?

Diagnosis.—Massive Pericardial Effusion

The echocardiogram shows a large pericardial effusion in front of and behind the heart. Swinging of the heart with every other cardiac cycle results in the electrical alternans seen in the accompanying ECG. Cardiac oscillation within a large pericardial effusion most commonly occurs with every cardiac cycle rather than with alternate cycles, as in this case. This swinging distorts valvular motion and can mimic, for example, mitral prolapse. In pericardial tamponade, notching of right ventricular epicardial motion shortly after the QRS (seen in Fig 1) has been noted along with decreased . . . [Full Text PDF of this Article]

Author Affiliations
From the Section of Cardiology, Hines Veterans Administration Hospital, Hines, III, (Dr Jacobs) and the Cardiology Graphics Section, Northwestern University School of Medicine, Chicago (Dr Talano).

Footnotes
Accepted for publication Jan 4, 1978.

Reprint requests to Cardiology Graphics Section, Northwestern Memorial Hospital, 251 E Chicago Ave, Chicago, IL 60611 (Dr Talano).

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