NEJM -- Case 22-2004 - A 30-Year-Old Woman with a Pericardial Effusion

Presentation of Case

A 30-year-old woman was admitted to the hospital because of fever, cough, shortness of breath, and a pericardial effusion.

Approximately one month earlier, the woman had noticed an increased heart rate and fluttering in her neck when she bent over; both were relieved when she stood upright. During these episodes, her heart rate was 100 to 120 beats per minute. One week later, she noticed shortness of breath after walking up one flight of stairs. Since the age of 19 years, she had had intermittent atrioventricular nodal reentrant tachycardia, with heart rates of up to 180 beats per minute, and . . .