The fluoroscopic swinging heart: a rare sight for the modern interventionalist

Herein, we present the case of a 49-year-old woman who presented to a peripheral hospital with a 4-day history of progressive shortness of breath. Following a clinical diagnosis of heart failure and slightly elevated cardiac troponins on initial blood work, the patient was referred for same-day diagnostic coronary angiography, which revealed normal coronary arteries but the surprising finding of a fluoroscopic swinging heart due to a massive pericardial effusion. The patient promptly improved after emergent pericardiocentesis. Fluoroscopic clues to the diagnosis of pericardial effusion are reviewed, with accompanying illustrative video and hemodynamic tracings.