Just another chest pain patient… Courtesy of: Teresa Wu, MD; Gibrham Rodriguez, MD; Rachel Levitan, MD; Alex Williams, MD; Patrick Godwin, MD; Bruce Horwood, MD

A 49 y.o. female presents to the Copa ED with left sided chest pain that started approximately 3 weeks PTA. She has had a non-productive cough and has been feeling very weak. She typically runs 8 miles per day, but has been having increased dyspnea on exertion. Over the past few days, she has had some nausea and vomiting and epigastric pain. Her chest pain is described as pressure-like with intermittent stabbing pain. Her pain is worse at night when she lies flat, and feels better when she leans forward. She notes some intermitten diaphoresis associated with her chest pain. Her ROS is otherwise unremarkable. Her past medical history is only significant for a benign cyst in her ovary s/p oophorectomy. She has no pertinent family history. She does not smoke, drink, or use any illicit drugs.

Her initial vital signs included a HR of 109, BP of 111/79, RR of 18, O2 sat of 97% and temperature of 37.6 C. Her physical exam was unremarkable.

A focused cardiac ultrasound was performed at bedside. What do you see? What procedure should you consider?