Electrocardiogram of a 50 year-old woman with recurrent chest pains, fever, shortness of breath and anemia.

Rate 106/min
PR 0.14 sec
QRS 0.08 sec
QT 0.30 sec
QTc 0.40 sec
QRS axis +90º

Interpretation: Abnormal. Sinus tachycardia. Low voltage complexes. Non-specific repolarization changes.

Low voltage complexes could occur in obesity, hypothyroidism (with bradycardia), myocardial infiltration, pericardial effusion.

Echocardiogram documented large pericardial effusion with impending cardiac tamponade. The patient underwent urgent pericardiocentesis with removal of over 1000 ml of fluid. She was subsequently diagnosed with Still’s disease – adult-onset juvenile rheumatoid arthritis (pericarditis could be a part of its presentation).

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