A 47-year-old woman who is 2 weeks post triple bypass surgery


#1

A 47-year-old woman who is 2 weeks post triple bypass surgery presents to the ED with a chief complaint of sudden-onset, sharp chest pain for several hours. She is fatigued and short of breath. On physical examination, she has distended neck veins that grow more distended on inspiration. Muffled heart sounds are heard. Her temperature is 37.0°C (101.8°F), pulse is 133/min, blood pressure is 70/50 mm Hg, and respiratory rate is 30/min. Her O2 saturation is 100%. An echocardiogram shows a large pericardial effusion and chamber collapse; therefore, pericardiocentesis is performed. Although a large amount of blood is aspirated, the patient’s clinical picture acutely worsens. Her pain level increases substantially, with pulse 150/min, blood pressure 60/41 mm Hg, and respiratory rate 30/min. Her O2 saturation is 100%. Repeat echocardiogram shows an even larger pericardial effusion with chamber collapse. Which complication of pericardiocentesis is most likely in this patient?

  • (A) Acute left ventricular failure with pulmonary edema
  • (B) Aspiration of 10 mL air into the pericardium
  • © Laceration of a coronary vessel
  • (D) Pneumothorax
  • (E) Puncture of the left ventricle

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