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A 74yo M with a history of end-stage renal disease, on hemodialysis, presents with chest pain and shortness of breath. The patient reports he missed several sessions of dialysis. You obtain EKG which shows electrical alternans and low voltage QRS complexes. The patient is tachycardic, hypotensive, and has jugular venous distention. A bedside echocardiogram shows a pericardial effusion.