Figure 1From: Sometimes when you hear hoof beats, it could be a zebra: consider the diagnosis of Fabry disease Apical four-chamber ECHO demonstrating: a 3.5 cm pericardial effusion apically (at the cursor) and more than 4 cm around the anterior wall; right atrial collapse from resulting tamponade and; although there was no evidence of left ventricular hypertrophy, the highly echogenic myocardium is also typical of Fabry's. Back to article page