WAEL TANTAWY MD

CONSTRECTIVE PERICARDITIS

CASE PRESENTATION

Etiology

Historically, the most common cause of conestrictive pericarditis was TB pericarditis, however, now it is rare.

Other causes include recurrent episodes of viral or purulent pericarditis.

post-cardiac injury/surgery.Neoplastic pericarditis, mediastinal

radiation, chronic uremia, orCollagen vascular disease.

Echo in Constrictive pericarditis

Certain echo findings are consistent with the diagnosis of constrictive pericarditis

Pericardial effusion ± fibrinous adhesions.Pericardial thickening ± calcification which

may appear as multiple linear & parallel echoes posterior to the LV by M-mode

Abnormal septal motion: septal “bounce” diastolic “checking,” septal “shudder”

“Flattening,” of the LV during mid- to late diastole, due to stiff pericardium(in 85% of pts

Echo in Constrictive pericarditis CONT

Doppler provides further evidence of constrictive physiology.

Transmitral Pulsed Doppler shows increased E velocity & reduced A-wave velocity, due to impaired late diastolic filling.

Marked respiratory variation may be noted in early diastolic filling, with >25% increase of TV flow & >25% decrease of MV flow during inspiration

clinical presentation

The clinical presentation of constrictive pericarditis is usually subtle and gradual.

The Patients may C/O weakness, fatigue, & anorexia exertional

dyspnea and peripheral edema. Physical findings reflect the consequences

of chronically elevated heart pressures,

Case ICase I

40 y S/M 40 y S/M K/C of ESRD on dialysis & sever K/C of ESRD on dialysis & sever

osteoprosis.osteoprosis.Presented with hypotension & SOB.Presented with hypotension & SOB.TTE done showed pericardial effusion TTE done showed pericardial effusion

(managed medically by increased dialysis (managed medically by increased dialysis cession)cession)

2 months later he presented by recurrent 2 months later he presented by recurrent attacks of tachy arrhythmia (S.tachycardia attacks of tachy arrhythmia (S.tachycardia & SVT) & SVT)

Case II27y male

History of RTA 2y ago complicated by haemopericardium and pericardiocentesis was done twice in Rhyad.

Presented with 3 months history of exertional SOB, abdomenal distention & LL oedema.

Case III38Y FEMALEExertional SOB FC II-III/IVHistory of flue like symptoms two weeks

beforeDiagnosed as viral pericarditis with

moderate pericardial effusion, ttt medically6 monthes later started to have

progressive exertional SOB with paroxysmal attacks of irrigular palpitation

48 h holter revealed PAF