A 50-year-old woman has had progressive dyspnea over the past 2 weeks and constant, sharp chest pain for 4 days. The pain is localized to the center of the chest and is worse while supine. She underwent a right, modified radical mastectomy and adjuvant chemotherapy for breast cancer 3 years ago. She has a history of hypothyroidism treated with thyroid replacement therapy. She has smoked one pack of cigarettes daily for 30 years and drinks two ounces of alcohol daily. She is dyspneic and diaphoretic. Her temperature is 37.2 C (99 F), blood pressure is 90/70 mm Hg with a pulsus paradoxus of 20 mm Hg, pulse is 110/min, and respirations are 28/min. Examination shows jugular venous distention to the angle of the mandible. The liver span is 14 cm with 4 cm of shifting abdominal dullness. Arterial blood gas analysis on room air shows a pH of 7.50, PCO2 of 30 mm Hg, and PO2 of 70 mm Hg. An x-ray film of the chest shows an enlarged cardiac silhouette with a globular configuration. An ECG shows sinus tachycardia with nonspecific ST-segment changes diffusely. Which of the following is the most appropriate next step in management?
A ) Echocardiography
B ) CT scan of the abdomen
C ) Ventilation-perfusion lung scans
D ) Bronchoscopy
E ) Paracentesis
Dr_kholioo Forum Junior
Topics: 9 Posts: 74
03/08/07 - 05:39 AM
#2
yess cardiac tamponade Edited by Dr_kholioo on 03/09/07 - 05:32 AM
___________________ “We all have great inner power. The power is self-faith. There's really an attitude to winning. You have to see yourself winning before you win. And you have to be hungry. You have to want to conquer.” Arnold Schwarzenegger
huyniid Forum Elite
Topics: 9 Posts: 199
03/08/07 - 05:49 AM
#3
E. Cardiac tamponade due to pericardium metastasis, possibly from breast CA. Note pulsus paradoxus
dr_jojo
03/08/07 - 07:45 AM
#4
confusing
NE Forum Guru
Topics: 53 Posts: 504
03/08/07 - 08:24 AM
#5
The diagnosis is cardiac tamponade, for sure.The treatment is pericardiocentesis but I think you have to confirm first so go to echo.
dr in trouble Forum Guru
Topics: 62 Posts: 601
03/08/07 - 04:37 PM
#6
The diagnosis is pericardial effuion which is complicated by pericarditis (sharp pain and ST changes) , te diagnosis is confirmed by chest xray and ECG so the next step is to do pericardiocentesis to relieve the pressure. ___________________ If u want to do something, do it today as there is no tomorrow.
robin082006 Forum Hero
Topics: 471 Posts: 5,125
03/08/07 - 04:49 PM
#7
E ) Paracentesis ___________________ The Key to Succeed is Patience.
Dr_kholioo Forum Junior
Topics: 9 Posts: 74
03/09/07 - 05:34 AM
#8
noway effusion has no cardiac tamponade ___________________ “We all have great inner power. The power is self-faith. There's really an attitude to winning. You have to see yourself winning before you win. And you have to be hungry. You have to want to conquer.” Arnold Schwarzenegger
Adam Forum Senior
Topics: 6 Posts: 136
03/09/07 - 01:43 PM
#9
It's cardiac tamponade -not only effusion as there's pulsus paradoxus which go with tamponade -..
I guess we still have to confirm it first by echo,
___________________ I will not say I failed 1000 times.. I will say that I discovered there are 1000 ways that can cause failure ..
dr_jojo
03/09/07 - 02:19 PM
#10
Echo ,
92306 Forum Senior
Topics: 14 Posts: 126
03/09/07 - 03:21 PM
#11
A ) Echocardiography
robin082006 Forum Hero
Topics: 471 Posts: 5,125
03/09/07 - 03:35 PM
#12
He is distressed so paracentesis first ___________________ The Key to Succeed is Patience.
dr in trouble Forum Guru
Topics: 62 Posts: 601
03/11/07 - 04:33 PM
#13
Cardiac tamponade is clinical diagnosis, so if u r sure go for paracentesis. ___________________ If u want to do something, do it today as there is no tomorrow.
dr_jojo
03/11/07 - 04:46 PM
#14
with effusion there is pulsus paradoxus too , so go for echo and then paracentesis at the same time , it is not super emergency to go for paracentesis without echo
but in temponade it is , donot waste a min in any investigation
oblongata Forum Newbie
Topics: 0 Posts: 3
03/11/07 - 07:17 PM
#15
if it was pericardiocentesis i would take it since it is not offered so A echo but not e at all who cares for the ascites now?
krsna Forum Senior
Topics: 1 Posts: 211
03/12/07 - 02:03 AM
#16
i'ld go with A
fongch Forum Elite
Topics: 71 Posts: 316
05/07/07 - 03:23 PM
#17
robin082006 wrote: He is distressed so paracentesis first
But the respiratory distress is due to cardiac tamponade, right? Why do paracentesis first to remove some ascites?
usmle12 Forum Senior
Topics: 19 Posts: 194
05/07/07 - 04:26 PM
#18
well i think ppl have mistaken paracentesis with pericardiocentesis...so paracentesis is wrong so echo would be right
