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[A case of subacute effusive-constrictive pericarditis]
Y Yoshitomi1, T Katayama, Y Honda
1Department of Internal Medicine, Nagasaki City Hospital.
Kokyu to Junkan. Respiration & Circulation
|March 1, 1992
Summary
Effusive-constrictive pericarditis in a 30-year-old female caused significant diastolic dysfunction due to pericardial effusion and reduced compliance. Viral infection is suspected as the cause.
Area of Science:
- Cardiology
- Pathology
Background:
- Effusive-constrictive pericarditis is a rare condition characterized by fluid accumulation and fibrous thickening of the pericardium.
- This case highlights the diagnostic challenges and hemodynamic consequences of this condition.
Observation:
- A 30-year-old female presented with dyspnea, ascites, and edema, exhibiting pulsus paradoxus and a pericardial knock sound.
- Cardiac catheterization revealed elevated diastolic pressures in the right atrium, right ventricle, and pulmonary capillary wedge, persisting after pericardiocentesis.
- Characteristic right ventricular diastolic dip and plateau, along with deep atrial x and y descents, were noted.
Findings:
- Cardiac catheterization demonstrated significant diastolic dysfunction, with elevated diastolic pressures (approx. 30 mmHg, remaining 15 mmHg post-pericardiocentesis).
- Histological examination of the pericardium revealed diffuse lymphocyte infiltration and fibrosis, indicative of inflammation.
- The pressure waveform patterns strongly suggested impaired pericardial compliance as a primary contributor to diastolic dysfunction.
Implications:
- This case underscores the importance of considering decreased pericardial compliance in effusive-constrictive pericarditis beyond mere effusion.
- The findings suggest a potential viral etiology for the observed pericardial pathology.
- Accurate diagnosis and understanding of the underlying mechanisms are crucial for effective management of cardiac diastolic dysfunction in such cases.