Clip: Subxiphoid cardiac view showing clot in the pericardium impeeding diastolic filling of the right ventricle, the most specific echocardiographic sign of tamponade.
A middle aged F with a significant PMHx of HTN, HLD, asthma, and active smoker presented with acute onset chest pressure and dyspnea for an hour prior to arrival. Initial vitals significant for hypotension 70s/30s, however not tachycardic or hypoxic. Notably distressed, writhing in stretcher unable to find a comfortable position and tachypneic on exam. Lungs clear and no extremity edema noted. With POCUS echo, the diagnosis was made within 10 minutes of patient being in the ED. The patient went for a pericardial window, the clot was evacuated, and she did well. Great case. Drs Umphress and Elavunkal.
POCUS Cardiac: Subxiphoid view of the focused echo shows a pericardial effusion with a clot in the pericardium.
POCUS Pearl: This case nicely illustrates the utility of POCUS in the evaluation of undifferentiated dyspnea.