Constrictive Pericarditis
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John Ashurst
A 45-year-old woman presented to the emergency department with a 2-day history of intermittent left-sided chest pressure with associated dyspnea and syncope on exertion. Physical examination findings and medical history were unremarkable. Chest radiograph showed calcifications along the pericardial sac (image A), and computed tomographic image of the chest revealed a dense area of calcification along the pericardium (image B). The patient was transferred to a tertiary care facility, where she underwent pericardiectomy.
Constrictive pericarditis occurs when the pericardium becomes scarred, thickened, or calcified, causing decreased cardiac volume.1 Cardiac surgery and radiation therapy have replaced tuberculosis as the most common causes of constrictive pericarditis.2,3 In a recent study, 53% of patients with constrictive pericarditis from radiation, cardiac surgery, or tuberculosis were found to have calcium deposits in their pericardium.4 Patients usually have signs of right-sided heart failure, such as jugular venous distention, pulsus paradoxus, or a pericardial knock.1,3 Patients with pericardial calcifications may be more likely to have a pericardial knock on examination.5 Surgical pericardiectomy should be viewed as a potential curable intervention for these patients.
References
1. Little WC , FreemanGL. Pericardial disease. Circulation. 2006;113(12):1622-1632.10.1161/CIRCULATIONAHA.105.561514Suche in Google Scholar PubMed
2. Talreja DR , EdwardsWD, DanielsonGK, et al.Constrictive pericarditis in 26 patients with histologically normal pericardial thickness. Circulation. 2003;108(15):1852-1857.10.1161/01.CIR.0000087606.18453.FDSuche in Google Scholar PubMed
3. Miranda WR , OhJK. Constrictive pericarditis: a practical clinical approach [review]. Prog Cardiovasc Dis. 2017;59(4):369-379.10.1016/j.pcad.2016.12.008Suche in Google Scholar PubMed
4. Reinmuller R , GürganM, ErdmannE, KemkesBM, KreutzerE, WeinholdC. CT and MR evaluation of pericardial constriction: a new diagnostic and therapeutic concept.J Thorac Imaging. 1993;8(2):108-121.10.1097/00005382-199321000-00004Suche in Google Scholar PubMed
5. Ling L , BreenJ, SchaffH, et al.Calcific constrictive pericarditis: is it still with us [published correction appears in Ann Intern Med. 2000;133(8):659]?Ann Intern Med.2000;132(6):444-450.10.7326/0003-4819-132-6-200003210-00029Suche in Google Scholar
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Artikel in diesem Heft
- SPECIAL COMMUNICATION
- Insights on the Nationwide Project in Osteopathic Medical Education and Empathy (POMEE)
- SURF
- Perceptions of and Attitudes Toward Diabetes Among Chinese Americans
- OMT MINUTE
- Osteopathic Cranial Manipulative Medicine in the Setting of Concussion
- LETTERS TO THE EDITOR
- Patient Engagement in Coauthored Medical Records
- Response
- Tool for Predicting Medical Student Burnout From Sustained Stress Levels
- Response
- AOA COMMUNICATION (REPRINT)
- Official Call: 2018 Annual Business Meeting of the American Osteopathic Association
- AOA COMMUNICATION
- Proposed Amendments to the AOA Constitution, Bylaws, and Code of Ethics
- ORIGINAL CONTRIBUTION
- Reducing Health Disparities: Understanding the Unintended Effects of Health Care Professional and Patient Characteristics on Treatment
- Practice Area Intentions of Graduates of Colleges of Osteopathic Medicine: What Role Does Debt Play?
- BRIEF REPORT
- First-Year Osteopathic Medical Students’ Knowledge of and Attitudes Toward Physical Activity
- Osteopathic Manipulative Therapy Potentiates Motor Cortical Plasticity
- Safety of Osteopathic Cranial Manipulative Medicine as an Adjunct to Conventional Postconcussion Symptom Management: A Pilot Study
- JAOA/AACOM MEDICAL EDUCATION
- Use of a Clinical Pathologic Conference to Demonstrate Residents’ ACGME Emergency Medicine Milestones, Aid in Faculty Development, and Increase Academic Output
- CASE REPORT
- Primary Lung Signet Ring Cell Carcinoma Presenting as a Cavitary Pancoast Tumor in a 32-Year-Old Man
- CLINICAL IMAGES
- Constrictive Pericarditis
- IN YOUR WORDS
- Anastamosis
