University of Utah School of Medicine, Salt Lake City, UT, 84132, USA.
Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, UT, 84132, USA.
BMC Cardiovasc Disord. 2021 Nov 22;21(1):561. doi: 10.1186/s12872-021-02378-8.
Constrictive pericarditis (CP) is characterized by scarring and loss of elasticity of the pericardium. This case demonstrates that mixed martial arts (MMA) is a previously unrecognized risk factor for CP, diagnosis of which is supported by cardiac imaging, right and left heart catheterization, and histological findings of dense fibrous tissue without chronic inflammation.
A 47-year-old Caucasian male former mixed martial arts (MMA) fighter from the Western United States presented to liver clinic for elevated liver injury tests (LIT) and a 35-pound weight loss with associated diarrhea, lower extremity edema, dyspnea on exertion, and worsening fatigue over a period of 6 months. Past medical history includes concussion, right bundle branch block, migraine headache, hypertension, chronic pain related to musculoskeletal injuries and fractures secondary to MMA competition. Involvement in MMA was extensive with an 8-year history of professional MMA competition and 13-year history of MMA fighting with recurrent trauma to the chest wall. The patient also reported a 20-year history of performance enhancing drugs including testosterone. Physical exam was notable for elevated jugular venous pressure, hepatomegaly, and trace peripheral edema. An extensive workup was performed including laboratory studies, abdominal computerized tomography, liver biopsy, echocardiogram, and cardiac magnetic resonance imaging. Finally, right and left heart catheterization-the gold standard-confirmed discordance of the right ventricle-left ventricle, consistent with constrictive physiology. Pericardiectomy was performed with histologic evidence of chronic pericarditis. The patient's hospital course was uncomplicated and he returned to NYHA functional class I.
CP can be a sequela of recurrent pericarditis or hemorrhagic effusions and may have a delayed presentation. In cases of recurrent trauma, CP may be managed with pericardiectomy with apparent good outcome. Further studies are warranted to analyze the occurrence of CP in MMA so as to better define the risk in such adults.
缩窄性心包炎（CP）的特征是心包瘢痕形成和失去弹性。本例表明，混合武术（MMA）是 CP 的一个以前未被认识到的危险因素，其诊断支持心脏成像、左右心导管检查以及致密纤维组织无慢性炎症的组织学发现。
一名 47 岁的白人男性，来自美国西部，曾是混合武术（MMA）运动员，因肝损伤试验（LIT）升高和 35 磅体重减轻而就诊，伴有腹泻、下肢水肿、劳力性呼吸困难和疲劳加重，持续时间为 6 个月。既往病史包括脑震荡、右束支传导阻滞、偏头痛、高血压、与肌肉骨骼损伤相关的慢性疼痛和 MMA 比赛导致的骨折。他曾广泛参与 MMA，有 8 年的职业 MMA 比赛经历和 13 年的 MMA 搏击经历，胸部反复受到创伤。患者还报告了 20 年的性能增强药物（包括睾酮）使用史。体格检查发现颈静脉压升高、肝肿大和微量周围水肿。进行了广泛的检查，包括实验室研究、腹部计算机断层扫描、肝活检、超声心动图和心脏磁共振成像。最后，左右心导管检查——金标准——证实右心室-左心室的不协调，符合缩窄性生理学。心包切除术有慢性心包炎的组织学证据。患者的住院过程顺利，他恢复到纽约心脏协会（NYHA）心功能 I 级。
CP 可继发于复发性心包炎或血性渗出液，且可能表现延迟。在反复创伤的情况下，CP 可能通过心包切除术进行治疗，且预后良好。需要进一步的研究来分析 MMA 中 CP 的发生情况，以便更好地定义此类成年人的风险。
