A 68 YO WOMAN WITH WORSENING SOB

This year at the Cardiac Bootcamp face to face course in Sydney we had a fantastic turnout and we went over a huge amount of content in Acute Cardiology and reading ECGs.
There were some ECGs that we looked at, as part of the ECG Quiz.
​Here is one of those ECGs, to test your memory and to reinforce some of the most important things we learnt about this case.

A 68 yo woman presented with worsening SOB over the previous 24 Hours. She now also had chest pain and was speaking in very short phrases.
​She was a smoker, with a past medical history of COPD and hypertension.
Her vitals were:

• HR 115
• BP 87/42
• RR 31
• Sats 94% on room air
• Temp 36.2

Her examination showed dual heart sounds, with some crepitations in the right base and her abdo was soft.
Her blood pressure dropped to 65/32 before peripheral inotropes were commenced.
Her ECG and Chest Xray are shown below. What is your diagnosis?

There is a pericardia effusion diagnosed on LOW VOLTAGE CRITERIA.
Small complexes and tachycardia = pericardial effusion.
The are Sensitive Criteria and Specific criteria for picking low voltage on an ECG.

This was all part of the 'SHOCKED' A mnemonic on Cardiac Bootcamp Course, to minimise missed cases.

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