A 50-year-old woman presented with progressive dyspnoea and oedema with rapid deterioration over the last few days. Clinical examination revealed hypotension with cold clammy skin, raised jugular venous pressure and muffled heart sounds and was diagnosed to have cardiac tamponade, later confirmed on two-dimensional echocardiography. However, patient had bradycardia, and the other striking examination findings were coarse facies with pallor, madarosis, absent axillary and pubic hair and breast atrophy. Her blood sugar level was also low. Detailed history revealed an episode of postpartum haemorrhage with lactation failure and early menopause. Pericardiocentesis was done with a pig-tail catheter. Hormone profile and MRI brain confirmed the diagnosis of Sheehan's syndrome. Patient improved on treatment with thyroxine and hydrocortisone supplementation and was discharged with education about stress dosing.

No abstract

A man in his 50s presented to the emergency department with sudden-onset retrosternal chest pain for the preceding 14 hours. He had a history of smoking 1 pack per day for the previous 20 years. He had no medical history of diabetes, hypertension, or dyslipidemia. Physical examination revealed a pulse rate of 75 beats per minute and a blood pressure of 150/90 mm Hg. Chest examination findings were otherwise unremarkable. The Figure shows the electrocardiogram (ECG) taken at arrival.

No abstract

No abstract