A 65-year-old man with chronic obstructive pulmonary disease and right lung nodule presented with dyspnea. Physical examination revealed a pulse of 130 beats per minute, respiratory rate of 28 times per minute, blood pressure of 100/ 60 mm Hg, estimated jugular venous pressure of greater than 15 cm above the right atrium at a 45-degree semire-cumbent position, and distant heart sounds. He subsequently developed hypotension and an arterial line was placed. A single-channel electrocardiogram (Figure 1A; upper tracing) demonstrated electrical alternans. Simultane- ous arterial line (Figure 1A; lower tracing) showed decreased systolic blood pressure from 136 mm Hg (Figure 1A; arrow) to 96 mm Hg (Figure 1A; arrowhead) with inspiration, consistent with exaggerated pulsus paradoxus. A transthoracic echocardiogram confirmed a large pericardial effusion with the heart oscillating from side (Figure IB) to side (Figure 1C) within the pericardial sac. Pericardiocentesis was performed and 1100 mL of bloody pericardial fluid was removed with prompt resolution of hypotension, tachycardia, electrical alternans, and abnormal pulsus paradoxus.
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机译：一名65岁的男性，患有慢性阻塞性肺疾病和右肺结节，出现呼吸困难。体格检查发现，每分钟130次搏动，每分钟28次呼吸频率，血压为100/60毫米汞柱，在45度半卧位时，估计的右室上方颈静脉压力大于15厘米以及遥远的心声。随后，他发展为低血压，并放置了动脉线。单通道心电图（图1A;上图）显示了电交替。同时动脉线（图1A;较低的描迹线）显示，在有吸气的情况下，收缩压从136 mm Hg（图1A;箭头）降低到96 mm Hg（图1A;箭头），与脉搏夸张相一致。经胸超声心动图证实了大的心包积液，心脏在心包囊内从一侧（图1B）到另一侧（图1C）振荡。进行心包穿刺术并清除1100 mL血性心包积液，并迅速解决低血压，心动过速，电交替和异常脉搏悖论。
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