A woman in her 80s with hypertension and dyslipidemia was seen in the ED complaining of progressive dyspnea for 3 days. She was found to be tachypneic and hypoxemic and was admitted to the internal medicine service with a provisional diagnosis of heart failure. A thoracic CT scan revealed small bilateral pleural effusions, a small pericardial effusion, and no evidence of pulmonary embolism (PE). She was treated with diuretics and afterload reduction.
On hospital day 5, the patient complained of suddenly feeling generally unwell and was found to be hypotensive (systolic BP, 70 mm Hg). Her heart rate, respiratory rate, temperature, and oxygen saturation levels were normal. On further history taking, she admitted to a sensation of chest heaviness with no other features of typical angina. Her ECG revealed ST elevations, which were diffuse but most prominent in the lateral leads (V3-V6). Her physical examination was noncontributory. The hospital’s Rapid Assessment of Critical Events (RACE) team was called, and the patient was treated with acetylsalicylic acid po and a bolus of IV normal saline. Upon arrival, the RACE team performed a point-of-care ultrasound examination using a portable device (Videos 1-4).