[Heart Failure Despite Low BNP-Level: Paradoxon or Pathfinder? - - A Case of Pericarditis constrictiva]

We elaborate a case of a 48-year old patient of indian descent who presented with shortness of breath, lower extremity edema and ascites in our emergency unit.One year beforehand tuberculous pleuritis was diagnosed and treated in accordance with guidelines.

CT-Scan of the heart revealed a pericardial thickening with calcifications. Echocardiographic examination and invasive pressure measurement did not provide any clear evidence of pericarditis constrictiva. Coronary artery disease was ruled out. In laboratory tests, the BNP-level was noticeably low despite severe cardiac decompensation.

Due to a typically low BNP-level, pericarditis constrictiva was our suspected diagnosis TREATMENT AND COURSE:  After an intraoperative diagnosis confirmation by our cardiosurgery colleagues, a complete pericardiectomy was performed. In the follow up, the patient presented symptom-free and with normal capacity.

In case of incongruent findings, the BNP-level seems to be a useful additional diagnostic tool in the diagnosis of pericarditis constrictiva.