case_images: PMC6681595_01
case_images: ECG of the patient on admission showing atrial flutter with a ventricular rate of 126 beats/minute and T wave inversions in inferior and lateral leads.
case_images: CRIRH2019-6173276.001.jpg
case_images: PMC6681595_01_CRIRH2019-6173276.001.jpg
case_images: fig1
case_images: ECG tracing showed atrial flutter with a ventricular rate of 126 bpm (Figure 1).
case_images: Chest X-ray of the patient on admission demonstrating markedly enlarged cardiac silhouette with "water-bottle" appearance.
case_images: CRIRH2019-6173276.002.jpg
case_images: PMC6681595_01_CRIRH2019-6173276.002.jpg
case_images: fig2
case_images: Chest X-ray showed a markedly enlarged cardiac silhouette with a water-bottle appearance suspicious for pericardial effusion (Figure 2), for which an echocardiogram was done on hospital day 1, and confirmed the presence of a significantly dilated right ventricle, severe tricuspid, and moderate mitral regurgitation with no valvular structural abnormalities described.
case_images: Transthoracic ultrasound on admission: (a) apical four-chamber view and (b) subcostal four-chamber view showing a large pericardial effusion and dilated cavities. On Doppler and dynamic views, global hypokinesis and severe mitral regurgitation were appreciated (RA = right atrium; RV = right ventricle; LA = left atrium; LV = left ventricle).
case_images: CRIRH2019-6173276.003.jpg
case_images: PMC6681595_01_CRIRH2019-6173276.003.jpg
case_images: fig3
case_images: In addition, a moderately compromised left ventricular ejection fraction (LVEF) (30-40%) and a large pericardial effusion (Figure 3) were shown.