Contributed by Kimberly Monnin, MD and Edward C. Klatt, MD
--- Department of Pathology, University of Utah School of Medicine
Published on line in December 1996
A 71 year old female was admitted to hospital after having experienced neck pain and then having "passed out" while at home. She had a history of poorly controlled hypertension. In the Emergency Room, she exhibited transient left hemiparesis, bradycardia, and hypotension. A computed tomographic (CT) scan of the head showed no evidence for intracranial hemorrhage.
During hospitalization, she developed atrial fibrillation with hypotension and substernal chest pain. This was thought due to ischemic heart disease. She initially responded to oxygen by mask and to fluid resuscitation over the next three days. However, she then fell while ambulating. Several hours later, she was confused and disoriented. Left eye ptosis was noted, along with left hemiparesis, slurred speech, and dyspnea. Right radial and right carotid pulses were noted to be absent. Echocardiogram revealed a large amount of fluid in the pericardial cavity. Before further intervention, the patient died.
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