Constrictive pericarditis – challenges in determining the etiology

Introduction: Constrictive pericarditis represents a pathological entity with important functional impli-cations on a medium and long term. Adopting a right terapeutical attitude after the establishment of the etiology is essential.

Methods: We present you a case of a male pacient, age 69 years, big smoker, with a history of rheumato-id polyarthritis, viral hepatitis C, chronic pulmonary obstructive disease, essential arterial hypertension stage III who came at the clinique (hospital) accusing dyspnea at medium intensity effort.

Results: Clinically at admission, the pacient had a sta-ble hemodynamic status, with a murmur due to aortic atheromatosis, turgid jugular veins stage IV and discret bilateral leg edema. At home the pacient was taking an immunomodulatory treatment (Leflunomidă, Predni-son, Sulfasalazina) and a triple antihypertensive terapy (Candesartan, Bisoprolol, Rilmenidina). The biological data showed the presence of a inflamatory syndrome, a normocytic and normosideremic anemia syndrome, a cholestasis syndrome, hypothyroidism and elevated seric values of NT-proBNP. The radiological investiga-tions showed no patological modifications concerning the heart, except a small pleural fluid mass on the ri-ght side. The abdominal echography revealed a liver of normal dimensions, echogenic and with a granular structure. The Ecocardiography established the presen-ce of concentric left ventricular hipertrophy with the preservation of Left ventricular global systolic functi-on, diastolic disfunction type II, aortic atheromatosis, mild aortic regurgitation, right dilated cavities, with hypertrabeculated apex and a thickened pericard and also raised velocities at the basal segment of the right ventricule, mild pulmonary hypertension. The toracic computer tomography confirmed the diagnostic of constrictive pericarditis, with a right pleural effusion, pulmonary fibrotic changes on both sides and nonspe-cific lung nodules.

Conclusions: Determining the etiology for the con-strictive pericarditis was in this case difficult, but it was essential for the right terapy and prognostic of the pa-cient on a medium and long term.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)