Rather than a case description, it’s just an ECG this time, obtained from a middle-aged man almost two decades ago.

ECG Quiz.
ECG Quiz.

Question: What is the ECG diagnosis?

[Updated 24th January 2015]

The ECG shows short voltages on all leads, and electrical alternans (i.e. alternating taller and shorter voltages) on the long lead 2 at the bottom. These are signs of significant pericardial effusion, and electrical alternans is also an ECG sign for cardiac tamponade. The case is further described in the subsequent clinical vignette.