From a Cold to Cardiac Tamponade: A Case Report

Background and Clinical Significance: Chest pain is a common reason for activating emergency medical services and can be associated with a wide range of conditions. Rapid identification of life-threatening causes, such as cardiac tamponade, is crucial for timely intervention and improved patient outcomes. In this case neither the clinical signs nor the electrocardiogram (ECG) suggested the diagnosis, which was established by point-of-care ultrasound. Case Presentation: We report the case of a 70-year-old man with cardiovascular risk factors, whose initial presentation suggested stable chest pain. The prehospital electrocardiogram showed a nonspecific pattern with 1 mm ST elevation in leads V1 to V3 with lateral ST depression, without PR-segment depression or low QRS voltage. He rapidly developed shock of undetermined cause, which was managed in the field with fluids and vasopressors. Focused cardiac ultrasound in the emergency department revealed cardiac tamponade, and emergent pericardiocentesis drained 400 mL of hemorrhagic fluid. After an extensive work-up, presumed viral pericarditis was retained, with no recurrence over almost two years. Conclusions: A nonspecific ECG does not exclude pericardial disease, and normal QRS voltage does not exclude cardiac tamponade in unexplained shock. Point-of-care ultrasound is a valuable tool for diagnosing cardiac tamponade; its prehospital application is a promising area for development, supported by provider training and resource availability.