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  1. J Correia,
  2. J Santos,
  3. L Gonçalves
  1. Cardiology, Centro Hospitalar Tondela - Viseu, Viseu, Portugal
  1. Correspondence to Dr J Correia, Cardiologia, Centro Hospitalar Tondela Viseu EPE, Viseu 3504-509, Portugal; joanalaranjeira11166{at}gmail.com

https://doi.org/10.1136/emermed-2021-211947

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    Clinical introduction

    A 61-year-old man with a history of smoking and heavy alcohol consumption was admitted to the intensive care unit with an inferior ST-elevation myocardial after successful fibrinolysis and temporary pacemaker (TP) implantation for junctional rhythm. In the first 24 hours, the patient demonstrated haemodynamic and electric instability with ventricular tachycardia requiring electrical cardioversion and vasopressor support. He underwent urgent coronary angiography via right femoral access that allowed circumflex angioplasty.

    The TP was removed 24 hours after implantation. A few minutes later, the patient became severely hypotensive, tachycardic and diaphoretic.

    A bedside echocardiogram was performed (figure 1).

    Figure 1

    Bedside echocardiogram (subcostal view).

    Question

    What is the most likely diagnosis?

    1. Cardiac tamponade …

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    Footnotes

    • Contributors All authors contributed to the approach, differential diagnosis and treatment during the hospitalisation of this patient. Furthermore, they contributed to the discussion, development and revision of this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.