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Figure A
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Figure B
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Figure C
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Figure D
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Figure E
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This patient presents with signs and symptoms consistent with pericardial effusion secondary to systemic lupus erythematous (SLE). Figure A shows alternations in the amplitudes of the QRS complex due to movement of the heart in a fluid filled sac, which is referred to as electrical alternans. Pericardial effusions are caused by a buildup of fluid within the pericardial sac that surrounds the heart. This accumulation increases the pressure within the pericardial as. and leads to decreased heart function. Although patients can be asymptomatic, pericardial effusion can present with chest pain and dyspnea. If the effusion is large enough to impair heart function, it can lead to a cardiac tamponade, which is a life-threatening condition. Pericardial effusions can be caused by many different entities, including autoimmune and inflammatory conditions (SLE, Dressler's syndrome), pericarditis, malignancies, infections, and trauma, among others. Tingle et al. state that pericarditis is an inflammation of the pericardium that can be caused by a multitude of conditions, such as infection, medications, and systemic disease. Pericardial effusions are a complication of acute pericarditis. Pericarditis results in accumulation of fluid that surrounds the myocardium. If the pressure of the pericardial effusion exceeds the diastolic filling pressure, cardiac tamponade and death can occur. Chen et al. review the cardiac manifestations of systemic lupus erythematous in 8 cases. It is believed that 50% of patients with SLE will experience cardiac involvement. Pericardial effusion and mitral regurgitation were found to be the most common cardiac complications, both occurring in 63% of the patients followed. They recommend that patients presenting with cardiac symptoms with no clear history should be evaluated for an underlying cause, such as lupus. Figures A-E are described below in the incorrect answers section. Figure F shows a chest radiograph with a 'water-bottle heart' sign, which represents the enlarged cardiac silhouette seen with pericardial effusions. Incorrect answers: Answer 2: Figure B is an electrocardiogram showing atrial fibrillation, which is not associated with pericardial effusions. Answer 3: Figure C is an electrocardiogram showing second degree heart block type 2, which is not associated with pericardial effusions. Answer 4: Figure D is an electrocardiogram showing prolonged QT and torsades de pointes, which are not associated with pericardial effusions. Answer 5: Figure E is an electrocardiogram showing atrial flutter, which is not associated with pericardial effusions.
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