A 63 year old man presents with acute onset of breathlessness and chest pain. Associated symptoms include diaphoresis and syncope. He has a history of acute pain and swelling in his right calf one week prior to the incident. He had not taken any medical advice for this complaint. Presently he is not under any medications and does not have any history of diabetes, hypertension, asthma or heart disease. He is a chronic smoker and alcoholic.
On examination he is tachypneic with oxygen saturation of 80% and cold cyanotic extremities. Peripheral pulses were weak and his systolic blood pressure is 50mmHg. Cardiac evaluation revealed tachycardia, elevated JVP, a fixed wide split of second heart sound and audible third heart sound at the left sternal border. Bilateral crepitations and rhonchi were present on the lung fields. ECG revealed sinus tachycardia, RBBB and diffuse ST segment…
