A 72-Year-Old Woman With Fatigue and Progressive Dyspnea: Osmosis USMLE Study Question

July 10, 2020

The patient in the vignette is experiencing constrictive pericarditis, a condition characterized by incomplete filling of the cardiac chambers due to thickening of the parietal pericardium. When this happens, the abnormal pericardium cannot stretch to accommodate physiologic changes in cardiac volume. Therefore, patients often present with a pericardial knock due to the ventricles hitting the thickened wall, whereas some others can have an absent apical impulse.

Similarly, with jugular venous pressure, the y descent usually corresponds to the right atrium emptying into right ventricle and is prominent. Tuberculosis is the most common cause of constrictive pericarditis worldwide; however, in some cases, scarring or calcification of the pericardium can occur due to uremic states (ie, chronic renal failure) or previous open heart surgery. Chest radiography usually reveals dystrophic calcification. The definitive treatment for constrictive pericarditis is pericardial stripping, which is a surgical procedure where the entire pericardium is peeled away from the heart.

Major Takeaway: Constrictive pericarditis is a condition characterized by incomplete filling of the cardiac chambers due to thickening of the parietal pericardium. Patients often present with fatigue, hepatomegaly, and dyspnea because the pericardium cannot accommodate changes in cardiac volume.

Read more about constrictive pericarditis.

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