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Diagnosis of constrictive pericarditis obscured by hypertrophic cardiomyopathy: Back to basics

Chance M Witt1, Mackram F Eleid1, Rick A Nishimura1

  • 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 3, 2015
PubMed

Insights

This case study highlights a patient with hypertrophic cardiomyopathy and constrictive pericarditis. Classic hemodynamic signs, despite atypical modern criteria, led to successful pericardiectomy and improved heart function.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Cardiac Physiology

Background:

  • Hypertrophic cardiomyopathy (HCM) and constrictive pericarditis (CP) are distinct cardiac conditions.
  • Co-occurrence of HCM and CP presents diagnostic challenges.
  • Right-sided congestive heart failure symptoms necessitate accurate diagnosis.

Observation:

  • A 41-year-old male with HCM presented with right-sided heart failure.
  • Noninvasive tests for CP were inconclusive.
  • Invasive hemodynamic catheterization was performed for definitive diagnosis.

Findings:

  • The patient exhibited classic hemodynamic criteria for CP, including early rapid filling and diastolic pressure equalization.
  • Modern echocardiographic and invasive criteria for CP were not met due to enhanced ventricular interdependence from HCM.
  • Diagnosis of CP was confirmed through classic hemodynamic findings.

Implications:

  • This case underscores the importance of considering classic hemodynamic criteria in diagnosing CP, especially in complex cases.
  • Accurate diagnosis of co-existing HCM and CP is crucial for appropriate treatment.
  • Pericardiectomy resulted in significant clinical improvement, validating the diagnosis and intervention.

Keywords:
computed tomographyconstrictive pericarditisechocardiographyhemodynamic catheterizationhypertrophic cardiomyopathy

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