Effusive Constrictive Pericarditis, A Heart Failure Mimicker
Background Effusive constrictive pericarditis can initially mimic heart failure and ultimately result in cardiogenic shock. Case Patient is a 57-year-old female with history of recent massive pulmonary embolism status post systemic alteplase, chronic diastolic heart failure, and history of COVID-19 infection presenting with increasing dyspnea on exertion and weakness despite compliance to outpatient diuretics. Patient was noted to be hypotensive, and fluid overloaded on exam. Decision-making Due to concern for constriction right heart catheterization (RHC) was completed and showed cardiac index of 1.1 with elevated filling pressures, discordant variation of right ventricle (RV) and left ventricle (LV) pressure tracings, diastolic equalization of pressure, and dip and plateau pattern of RV and LV diastolic tracing suggestive of constrictive physiology. Transesophageal echocardiogram showed no pericardial effusion with increased echo-density of the pericardium. Cardiac MRI showed mild diffuse thickening and subtle enhancement of the pericardium with septal bounce and no significant pericardial effusion consistent with constrictive pericarditis. Due to persistent hypotension requiring milrinone infusion, the patient underwent pericardiectomy with improvement of hemodynamics and symptoms. Conclusion Effusive constrictive pericarditis can mimic heart failure and should be ruled out in those with evidence of low cardiac output to avoid cardiovascular morbidity and mortality. [Formula presented]
J. Am. Coll. Cardiol.
Zachariah, S., Nasir, U., & Waheed, T. (2023). Effusive Constrictive Pericarditis, A Heart Failure Mimicker. J. Am. Coll. Cardiol., 81 (8), 3572-3572. https://doi.org/10.1016/S0735-1097(23)04016-0