Periodical
Abstract 16449: New Onset Heart Failure Due to Effusive Constrictive Pericarditis
| العنوان: | Abstract 16449: New Onset Heart Failure Due to Effusive Constrictive Pericarditis |
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| المؤلفون: | Al-Saiegh, Yousif, Williams, Philip, Barry, Timothy, Impens, Elias, Spears, Jenna, Manthey, Sina |
| المصدر: | Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA16449-A16449, 1p |
| مستخلص: | Introduction:Effusive constrictive pericarditis (ECP) is a rare syndrome characterized by constriction of the heart by the visceral pericardium in the presence of cardiac tamponade caused by fluid accumulation in the pericardial space. The syndrome is often identified when hemodynamic features consistent with constrictive pericarditis remain after drainage of fluid from the pericardial space. An estimated 6.9% of patients with cardiac tamponade have ECP, though epidemiological data is limited.Case History:71 year old male with atrial fibrillation, hypertension who presented with a 5 day history of chest pain with dyspnea on exertion as well as hypoxia. Vitals were notable for an SpO2 of 85%, hypotension, and tachycardia. Physical exam was notable for muffled heart sounds. EKG showed sinus tachycardia with low voltage. An echocardiogram confirmed a large circumferential pericardial effusion. Gentle IV fluid resuscitation was initiated. We performed a subxiphoid pericardiocentesis and window with drainage of 400ml of fluid. Biopsy revealed fibroadipose tissue with focal chronic inflammation. MRI showed atrial enlargement and a tubular configuration of the ventricles as well as a septal bounce on deep inspiration, consistent with pericardial constriction. Autoimmune workup was unrevealing. Patient was discharged 4 days after the procedure. The patient represented 1 week later with shortness of breath. Serial echocardiograms revealed increasing pericardial fluid which was drained emergently, rapidly resulting in improvement of his symptoms. Repeat echocardiogram demonstrated abnormal hemodynamics consistent with constrictive disease. A persistent pericardial effusion improved with a pericardial drain in place and a repeat echo did not show a re-accumulation of fluid. The patient was discharged on Colchicine.Conclusions:The underlying etiologies of ECP include infection, malignancy, and autoimmune processes. The diagnosis requires a high clinical suspicion. Treatment includes pericardiocentesis or pericardial window and addressing underlying etiology. Evidence regarding the prognosis and optimal treatment is limited. Anti-inflammatory agents are first line, but patients often require pericardiectomy. |
| قاعدة البيانات: | Supplemental Index |
Full Text Finder | تدمد: | 00097322 15244539 |
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| DOI: | 10.1161/circ.140.suppl_1.16449 |