History A 68-year-old man on treatment for non-Hodgkin’s lymphoma presents to the accident and emergency department with mild chest discomfort, worse on lying flat and eased by leaning forward. It has been getting slowly worse over the last few weeks. Now he gets dizzy on standing, rapidly breathless on exertion and has noticed some bilateral ankle swelling over the last week. He does not have a significant past cardiac or respiratory history. Examination On examination, his blood pressure is 144/88, pulse 94/minute and respiratory rate 22/minute.
The JVP is a little raised and fine crackles are heard at both lung bases. The heart sounds are difficult to hear but otherwise regular. The abdomen is soft and there is moderate left flank tenderness to deep palpation. The electrocardiogram (ECG) shows small QRS complexes and T wave inversion. The physician organizes a chest radiograph (Image…
