24th May 2025

A 28-year-old male is referred to you by the urgent GP service with a 1-week history of exertional dyspnea, most notable upon climbing the steps of his university dormitory.

A 28-year-old male is referred to you by the urgent GP service with a 1-week history of exertional dyspnea, most notable upon climbing the steps of his university dormitory. He is usually fit and well. ECG on admission revealed T wave inversions in leads I, II, III, aVF, V2, V4-V6. These changes were not present when compared to an ECG from a previous admission. An echocardiogram revealed global biventricular dysfunction, with the ejection fraction estimated at 10-15%. The impression was made of acute myocarditis. The hospital you are working at cannot perform CMR; therefore, the patient is referred to a tertiary centre for an endomyocardial biopsy. Pre-procedure, his observations were as follows: BP 124/83 mmHg, HR 84 bpm, SO2 94% on room air, RR 18 and temperature of 37.2°C. The procedure is started; however 10 minutes into it, the patient has become markedly breathless and drowsy. Repeat observations are BP 89/64 mmHg, HR 120 bpm, SO2 89% on 15 litres O2, RR34 and temperature of 37.3°C. On inspiration, the systolic blood pressure is noted to drop to 75mmHg. You notice the patient’s jugular veins are distended, and heart sounds are muffled on auscultation. What complication of endomyocardial biopsy is most likely to have occurred in this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.