van Deuren M, Hoefenagels W H, van Haelst U G, van Leeuwen K, Skotnicki S H, van Tongeren J H
Afd. Maag-, darm- en leverziekten, Sint-Radboudziekenhuis, Nijmegen.
Ned Tijdschr Geneeskd. 1990 Oct 6;134(40):1947-50.
Constrictive pericarditis is a slowly progressive disabling disease. The diagnosis is easily overlooked because of the striking extracardial signs and symptoms such as abdominal discomfort, general fatigue, cachexia, ascites and oedema. We describe 7 patients with these symptoms in whom the diagnosis was missed during 0.5-17 years. The decisive clue for correct diagnosis appeared to be the raised central venous pressure. This proves the importance of an accurate physical examination. Other findings were: ascites (7/7), hepatomegaly (7/7), oedema (6/7), narrow pulse pressure (less than or equal to 35 mmHg) (5/7), ECG abnormalities (7/7) and pericardial calcifications on the chest X-ray (5/7). In addition we found slightly raised liver enzymes and a protein-losing enteropathy leading to low serum protein levels. These abnormalities are all explained by the alterations in haemodynamics and lymph flow. The only curative therapy is surgical decortication of the heart.
缩窄性心包炎是一种缓慢进展的致残性疾病。由于存在显著的心外体征和症状，如腹部不适、全身乏力、恶病质、腹水和水肿，该疾病的诊断很容易被忽视。我们描述了7例有这些症状的患者，他们在0.5至17年期间均被漏诊。正确诊断的决定性线索似乎是中心静脉压升高。这证明了准确体格检查的重要性。其他发现包括：腹水（7/7）、肝肿大（7/7）、水肿（6/7）、脉压变窄（小于或等于35 mmHg）（5/7）、心电图异常（7/7）以及胸部X线显示心包钙化（5/7）。此外，我们还发现肝酶轻度升高以及导致血清蛋白水平降低的蛋白丢失性肠病。这些异常均由血流动力学和淋巴液流动的改变所解释。唯一的治愈性疗法是心脏外科剥脱术。
