Ultrasound for Critical Care Physicians: The Big Squeeze

A 57 year-old man without significant past medical history presented with difficulty swallowing and pleuritic chest pain.  He was undergoing evaluation for his dysphagia when he was noted to be tachycardic and hypotensive shortly after admission to the medical-surgical ward.  His initial chest x-ray revealed bilateral pleural effusions and what appeared to be cardiomegaly. A cardiac ultrasound was performed (Figure 1).

Figure 1. Subxiphoid view of patient's heart, inferior vena cava and hepatic vein.

What is the cause of the patient's tachycardia and hypotension?

1. Aortic dissection
2. Cardiac tamponade
3. Cardiomyopathy
4. Mitral insufficiency
5. Pulmonary embolus

Reference as: Siddiqi T, Assar S, Malo J. Ultrasound for critical care physicians: the big squeeze. Southwest J Pulm Crit Care. 2014;8(4):221-2. doi: http://dx.doi.org/10.13175/swjpcc036-14 PDF