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. 2021 Mar 10;24(2):99-101.
doi: 10.1002/ajum.12241. eCollection 2021 May.

Syncope and undifferentiated shock

Daniel Trotzky  1 , Ali Amer  1 , Salha Fraij  1 , Daniel E Fordham  1 , Gregory Granovsky  1 , Uri Aizik  1 , Natali Carady  1 , Aya Cohen  1 , Shmuel Fuchs  2 , Bethlehem Mengesha  2 , Oleg Burgsdorf  2 , Inna Yofik  2 , Ari Naimark  3 , Inbal Baruch  3 , Yaron D Barac  3 , Gal Pachys  1
Affiliations

Syncope and undifferentiated shock

Daniel Trotzky et al. Australas J Ultrasound Med. .

Abstract

Ventricular free wall rupture is a rare post myocardial complication with a high associated mortality. In this article we discuss the case of an elderly patient who presented to our emergency department in shock after an episode of syncope. Using Point Of Care Ultrasound (POCUS), identification of cardiac tamponade and pericardial thrombus was possible, signs indicating a diagnosis of free wall rupture. Early initiation of transfer proceedings to a tertiary cardio-thoracic unit was therefore possible, resulting in a positive patient outcome.

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Conflict of interest statement

The authors have no commercial associations or sources of support that might pose a conflict of interest.

Figures

Figure 1
Figure 1
POCUS (RUSH protocol) demonstrating a large pericardial effusion, with a flaccid, hyperechogenic shadow within the pericardial cavity, left ventricular wall segmental akinesia and restricted expansion of the right ventricle. Additionally, paradoxical movement of the right atrium and dilation of the inferior vena cava were noted
Figure 2
Figure 2
CTA revealed a medium pericardial effusion with thrombus formation, infarct within the left wall of the LV with mild pulmonary oedema and no evidence of aortic dissection
Figure 3
Figure 3
A photograph taken during the surgical procedure. After the clot was excavated from the pericardium, the tear was visualised and subsequently repaired. The size of the defect, as demonstrated at the operating theatre, was 3–4 cm
See this image and copyright information in PMC

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