A 72 yo patient presents with what appears to be a pre syncopal episode at home. This is on a background history of having had a valve repair 3 weeks previously, with a pacemaker inserted.
The patient had been to the bathroom and within a short period of time after walking out, became pale and verbally not responsive according to his family, although there was no loss of consciousness. The patient has no memory of the event.
On ambulance arrival the Systolic Blood Pressure was 70 mm Hg. A fluid bolus was given and the patient improved rapidly.
On arrival to the emergency department GCS was 15 and the blood pressure was 128/62 and he was in a paced rhythm at a rate of 65 beats per minute.
His ECG was normal and a POCUS cardiac study, showed normal ventricular movement and a small pericardial effusion.
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