A 24-Year-Old Woman with Shortness of Breath

A 24-year-old woman presented to the emergency department via private vehicle. Her chief symptom was a 2-day history of frequent coughing, intermittent palpitations, and increasing shortness of breath. According to her father, the patient had been unable to sleep because she could not tolerate lying flat. Initial vital signs were as follows: temperature, 37.1°C (98.9°F); respirations, 32 per minute; heart rate, 142 beats per minute; and blood pressure, 100/64 mm Hg. A chest computed tomography scan was promptly ordered, and a cardiothoracic surgery consultation was requested. Because the patient was restless and unable to lay supine, lorazepam, 0.5 mg IV, was administered to facilitate the scan. Pericardial tamponade is a rare complication of a sternal biopsy, with an incidence of approximately 0.8%.1 Pericardial tamponade (also referred to as cardiac tamponade) is a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. Pericardial tamponade is a life-threatening condition. [...]rapid and reliable diagnosis is essential when tamponade is suspected.3 Prompt detection reduces mortality.