{"id":11,"date":"2013-05-03T11:30:00","date_gmt":"2013-05-03T11:30:00","guid":{"rendered":"http:\/\/amj.crankydeveloper.com\/?p=11"},"modified":"2014-01-08T11:45:35","modified_gmt":"2014-01-08T18:45:35","slug":"divulged-through-imaging","status":"publish","type":"post","link":"https:\/\/amjmed.org\/divulged-through-imaging\/","title":{"rendered":"Divulged through Imaging"},"content":{"rendered":"<h1>Imaging Divulged What Signs and Symptoms Didn’t: Acute Pericarditis<\/h1>\n<p><a href=\"https:\/\/i0.wp.com\/amjmed.org\/wp-content\/uploads\/2013\/07\/imaging-divulged.gif?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-437\" alt=\"imaging divulged\" src=\"https:\/\/i0.wp.com\/amjmed.org\/wp-content\/uploads\/2013\/07\/imaging-divulged.gif?resize=209%2C164&ssl=1\" width=\"209\" height=\"164\" \/><\/a>Shortness of breath in an 85-year-old man posed a diagnostic challenge. He presented with a 2-month history of progressively worsening dyspnea on exertion. Over the previous week, he also experienced orthopnea and bilateral lower-extremity edema. He denied chest pain or recent febrile illness. His medical history included heart failure with preserved systolic function and hypothyroidism. He was a nonsmoker, and his family history was not significant.<\/p>\n<p>On presentation, he had a temperature of 99.3\u00b0 F (37.4\u00b0 C), heart rate of 87 beats per minute, blood pressure of 124\/62 mm Hg, and respiratory rate of 20 breaths per minute. Physical examination revealed mildly distended jugular veins, bilateral basal lung crackles, normal heart sounds without murmurs, rubs, or gallops, and 2+ symmetric bilateral lower-extremity edema.<\/p>\n<p>The patient’s history and physical findings were consistent with decompensated heart failure. Intravenous diuretic therapy was started. A 12-lead electrocardiogram (ECG) showed normal sinus rhythm with right bundle branch block (Figure 1). A chest x-ray demonstrated an enlarged cardiac silhouette with left pleural effusion. This was further investigated with transthoracic echocardiography, which disclosed a moderate-sized pericardial effusion without evidence of tamponade physiology; the left-ventricle ejection fraction was preserved (Figure 2– shown above).<\/p>\n<p>To read this article in its entirety, please visit our <a href=\"http:\/\/www.amjmed.com\/article\/S0002-9343(13)00140-X\/fulltext\" target=\"_blank\">website<\/a>.<\/p>\n<p>— Tarun Jain, MD, Mushabbar A. Syed, MD<\/p>\n<p>This article originally appeared in the <a href=\"http:\/\/www.amjmed.com\/issues?issue_key=S0002-9343(13)X0004-X\" target=\"_blank\">May 2013<\/a> issue of <b><i>The American Journal of Medicine.<\/i><\/b><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Imaging Divulged What Signs and Symptoms Didn’t: Acute Pericarditis Shortness of breath in an 85-year-old man posed a diagnostic challenge. He presented with a 2-month history of progressively worsening dyspnea on exertion. Over the previous week, he also experienced orthopnea and bilateral lower-extremity edema. He denied chest pain or recent febrile illness. His medical history […]<\/p>\n","protected":false},"author":3,"featured_media":437,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[38,78,79,203],"tags":[],"class_list":{"0":"post-11","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-cardiovascular-disease","8":"category-diagnostic-images","9":"category-diagnostic-tests","10":"category-patient-care"},"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/amjmed.org\/wp-content\/uploads\/2013\/07\/imaging-divulged.gif?fit=209%2C164&ssl=1","jetpack_sharing_enabled":true,"jetpack_likes_enabled":true,"_links":{"self":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/posts\/11","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/comments?post=11"}],"version-history":[{"count":0,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/posts\/11\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/media\/437"}],"wp:attachment":[{"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/media?parent=11"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/categories?post=11"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/amjmed.org\/wp-json\/wp\/v2\/tags?post=11"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}