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CONSTRECTIVE PERICARDITIS CASE PRESENTATION

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  1. CONSTRECTIVE PERICARDITISCASE PRESENTATION WAEL TANTAWY MD

  2. 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, or • Collagen vascular disease.

  3. 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

  4. 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

  5. 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,

  6. Case I • 40 y S/M • K/C of ESRD on dialysis & sever osteoprosis. • Presented with hypotension & SOB. • TTE done showed pericardial effusion (managed medically by increased dialysis cession) • 2 months later he presented by recurrent attacks of tachy arrhythmia (S.tachycardia & SVT)

  7. Case II • 27y 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.

  8. Case III • 38Y FEMALE • Exertional SOB FC II-III/IV • History of flue like symptoms two weeks before • Diagnosed as viral pericarditis with moderate pericardial effusion, ttt medically • 6 monthes later started to have progressive exertional SOB with paroxysmal attacks of irrigular palpitation • 48 h holter revealed PAF

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