title: The importance of an ECG: back to basics.
abstract: A 48-year-old man presented to accident and emergency with syncope on a background history of 3&emsp14;weeks of increasing shortness of breath. He collapsed at home prompting admission. He was a smoker with a 30-pack-year history. On examination, he was found to be tachypnoeic and hypoxic, with a raised JVP and quiet heard sounds. He was haemodynamically stable and a chest x-ray showed right upper-lobe collapse. His resting ECG demonstrated electrical alternans prompting urgent referral to the cardiologist for echocardiography. This revealed a large pericardial effusion with evidence of right ventricular diastolic collapse. In view of this, he underwent urgent pericardiocentesis. A subsequent CT scan showed bilateral pleural effusions and multiple lung nodules. Both pericardial and pleural fluid cytology were reported as metastatic non-small cell adenocarcinoma. The pericardial fluid continued to reaccumulate requiring a pericardial window. He was referred to the oncology team for palliative chemotherapy.
authors.affiliation: Department of Genitourinary Medicine, St Thomas' Hospital, London, UK. ghaidari@doctors.net.uk
authors.forename: Golaleh
authors.initials: G
authors.lastname: Haidari
authors.forename: Kirsty
authors.initials: K
authors.lastname: Gray
authors.forename: Senthil
authors.initials: S
authors.lastname: Kirubakaran
mesh_terms: D018267:Carcinoma, Acinar Cell / Q000150:complications / Q000473:pathology*; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary*; D004417:Dyspnea / Q000209:etiology; D004562:Electrocardiography; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D016066:Pleural Effusion, Malignant / Q000209:etiology / Q000473:pathology*; D011859:Radiography; D013575:Syncope / Q000209:etiology