Images in Clinical Medicine
Swinging Heart
N Engl J Med 2004; 351:e1July 8, 2004
- Article
Video
Echocardiographic Study.
A 49-year-old man with small-cell lung carcinoma was admitted because of syncope. On examination, he had tachycardia (heart rate, 106 beats per minute), distended jugular veins, and muffled heart sounds. The blood pressure was 90/60 mm Hg. Pulsus paradoxus was not detected. The 12-lead electrocardiogram showed low QRS voltages with electrical alternans in multiple leads and flattening of the T waves (Panel A). Transthoracic echocardiography showed massive pericardial effusion and diastolic collapse of the right atrium and ventricle. Pericardiocentesis yielded 800 ml of fluid that was cytologically positive for pericarditis carcinomatosa. Immediately after the aspiration, the patient's hemodynamic condition improved. Correlation between the QRS alternation and a pendular swinging of the heart within the pericardial space is visible on the echocardiogram (Panels B and C and video clip).
Jurgen M. Akkerhuis, M.D.
Ferry M.R.J. Hersbach, M.D.
Catharina Hospital, Eindhoven, the Netherlands- Citing Articles (2)
Citing Articles
1
Laurent Bodson, Koceïla Bouferrache, Antoine Vieillard-Baron. (2011) Cardiac tamponade. Current Opinion in Critical Care 17:5, 416-424
CrossRef2
Lisa Johnston, Heidi O’Bra, Mickey Chopra, Cathy Mathews, Loraine Townsend, Keith Sabin, Mark Tomlinson, Carl Kendall. (2010) The Associations of Voluntary Counseling and Testing Acceptance and the Perceived Likelihood of Being HIV-Infected Among Men with Multiple Sex Partners in a South African Township. AIDS and Behavior 14:4, 922-931
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