Cardiac Tamponade as the Presenting Feature for Undiagnosed Malignant Metastatic Disease

A 63-year-old man with a 38 pack-year smoking history presented with four weeks of worsening cough and shortness of breath. He was initially treated for multifocal pneumonia and chronic obstructive pulmonary disease exacerbation. During the hospital stay, the patient became acutely hypotensive. Physical exam revealed a temperature of 97.8 degrees Fahrenheit, heart rate of 92 beats per minute, blood pressure 78/68, respiratory rate of 29 breaths per minute, and an oxygen saturation of 89% on room air. Physical examination revealed jugular venous distention and muffled heart sounds. An electrocardiogram (EKG) (Figure 1) and transthoracic echocardiogram (TTE) were obtained (Figure 2). Based on clinical presentation and imaging findings, the patient was diagnosed with cardiac tamponade. Cardiac tamponade is caused by accumulation of pericardial fluid that equalizes pressures between the pericardial sac and cardiac chambers leading to diastolic filling dysfunction with subsequent diminished cardiac output and resulting hemodynamic instability.