Konik Ewa, Geske Jeffrey, Edwards William, Gersh Bernard
Department of Medicine/Cardiology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Medicine/Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Case Rep. 2016 Nov 14;2016:bcr2016217563. doi: 10.1136/bcr-2016-217563.
A 70-year-old man presented with recent onset, predominantly right-sided heart failure. Echocardiogram demonstrated features of hypertensive heart disease and was suggestive of, but non-diagnostic for, constrictive pericarditis (CP). CT demonstrated mild pericardial thickening. Right heart catheterisation showed elevation and equalisation of diastolic pressures in all cardiac chambers with early rapid filling, minimal ventricular interdependence, and no dissociation of intrathoracic and intracardiac pressures. While several features pointed towards CP, the minimal ventricular interdependence and no dissociation of intrathoracic and intracardiac pressures suggested other pathology. Diagnostic pericardiectomy was performed, after which the central venous pressure decreased from 22 to 12 mm Hg. Pathology revealed pericardial fibrosis. The patient experienced sustained resolution of his heart failure. A potential explanation for lack of CP criteria was the presence of hypertensive heart disease. CP needs to be considered when approaching patients with heart failure as diagnostic evaluation can be multifaceted and treatment curative.
一名70岁男性近期出现主要为右侧心力衰竭的症状。超声心动图显示有高血压性心脏病的特征，提示可能存在缩窄性心包炎（CP），但不能确诊。CT显示心包轻度增厚。右心导管检查显示所有心腔舒张压升高且相等，早期快速充盈，心室相互依赖性极小，胸内压与心内压无分离。虽然有几个特征指向CP，但心室相互依赖性极小以及胸内压与心内压无分离提示存在其他病理情况。遂进行了诊断性心包切除术，术后中心静脉压从22毫米汞柱降至12毫米汞柱。病理检查显示心包纤维化。患者的心力衰竭症状持续缓解。缺乏CP标准的一个可能解释是存在高血压性心脏病。在诊治心力衰竭患者时需要考虑CP，因为诊断评估可能是多方面的，而治疗可能是治愈性的。
