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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).
What is the most likely diagnosis?
Cardiac tamponade …
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.
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