31 Constrictive pericarditis
Salient features
Examination
• The patient may appear cachectic.
• Pulse may be regular or irregularly irregular (one-third have atrial fibrillation).
• Prominent ‘x’ and ‘y’ descents in the JVP and the level of the jugular venous pulse may rise with inspiration (Kussmaul’s sign; Fig. 31.1).
• Apex beat is not palpable and there may be apical systolic retraction (Broadbent sign).
• Early diastolic pericardial knock along the left sternal border, which may be accentuated by inspiration.
• Lungs are clear but there may be pleural effusion.
• Markedly distended abdomen with hepatomegaly and ascites.
Fig. 31.1 Abnormal jugular venous waveform (JVP) in constrictive pericarditis with a prominent ‘y’ descent. Note the timing of the pericardial knock (K) relative to S2. The abrupt rise in pressure after the nadir of the ‘y’ descent is caused by the rapid rise in venous pressure with ventricular filling.
Diagnosis
This patient has constrictive pericarditis (lesion) caused by radiation therapy for previous Hodgkin’s disease (aetiology) and is now limited by dyspnoea and marked ascites (functional status).
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