Constrictive Pericarditis: When Horses Become Zebras

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2019-03-05

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TERHARK, MATTHEW

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Background: Disease of the pericardium can be broken down into 3 pericardial compressive syndromes. Of particular interest involving the following case is that of constrictive pericarditis. This disease process is typically secondary to loss of the normal elasticity of the pericardial sac. Precipitating factors for loss of physiologic elasticity of the pericardial sac include idiopathic, viral, connective tissue disorders, iatrogenic neoplastic processes. Case information: A 57yo male presented to PCP with upper respiratory symptoms, treated with antibiotics, failed to follow up with PCP initially. Continued to experience worsening shortness of breath, was referred to pulmonology who identified significant right sided infiltrate on chest x-ray. Patient directed to our facility where chest tube was placed and TPA administered for loculated pleural effusion. Patient required pressor support following administration and echocardiogram was obtained revealing pericardial calcifications. Patient underwent left heart catheterization followed by staged pericardiectomy then right sided thoracotomy. Patient tolerated procedure well and underwent an uncomplicated postoperative course. Conclusions: While the symptoms of upper respiratory infection often lead to a benign outcome the potential for adverse disease sequelae is broad. In this particular case the patients likely viral URI likely lead to the subsequent diagnosis of constrictive pericarditis. In order to prevent permanent and likely progressive symptoms as seen with constrictive pericarditis the patient underwent a pericardectomy within a week of identification. The patient tolerated this procedure well and had complete resolution of constrictive pericarditis symptoms. In general, Patients experiencing constrictive pericarditis typically present with symptoms related to fluid overload (i.e.-edema, ascites) owing to a diminished cardiac output. As seen with this patient, treatment often involves pericardiectomy otherwise patients are often left with permanent and progressive symptoms.

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