Reciprocal Changes in Ventricular Dimensions Related to Respiration

Bruce B. Lerman, MD; James V. Talano, MD; Sheridan N. Meyers, MD; Michael Lesch, MD
Arch Intern Med. 1980;140(5):685-687. doi:10.1001/archinte.1980.00330170101031.
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A 57-year-old man with a history of receiving radiation therapy for squamous cell carcinoma of the lung was admitted to the hospital because of dyspnea and dysphagia. Physical examination revealed a heart rate of 140 beats per minute and a blood pressure of 90/70 mm Hg with a pulsus paradoxus of 18 mm Hg. Jugular venous distention was difficult to evaluate. The ECG showed atrial fibrillation. Chest roentgenogram disclosed left perihilar fullness and cardiomegaly. The echocardiogram is shown (Fig 1).

What is your diagnosis?

Fig 1.—Pericardial effusion, PE; right ventricle, RV; interventricular septum, IVS; right ventricular internal diameter at inspiration, RVI; right ventricular internal diameter at expiration, RVE; left ventricular internal diameter at inspiration, LVI; left ventricular internal diameter at expiration, LVE; left ventricular posterior wall, LVPW; and pericardium, PERI. Lead II of ECG is shown at top of tracing.

The echocardiogram shows an anterior and


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