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Patient
78-year-old man who received an ICD for primary prevention of dilated cardiomyopathy with a 25% ejection fraction; 15 days after the procedure, dyspnea and low blood pressure;
Trace
This tracing shows a sinus rhythm; low-voltage QRS pattern (absence of QRS amplitude > 5 mm in limb leads);
A cardiac ultrasound revealed a significant pericardial effusion (2.5 cm circumference) with probable perforation of the right ventricular lead; pericardial puncture and repositioning of the right ventricular lead;
Trace
Tracing recorded after puncture; increase in QRS voltages (R wave exceeds 5 mm in leads I and aVL);
Exergue
The two main electrocardiographic signs observed during an abundant pericardial effusion are low voltage and electrical alternans.
Physiologically, the pericardial sac is filled with a serous liquid of small volume (between 15 and 50 ml). Various diseases can cause the occurrence of pericardial effusion (pathological increase in the volume of intrapericardial fluid) which can be serous, hematic, purulent or chylous.